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October 2015

Pregnancy Outcome Unit,  
SA Health

Pregnancy 
Outcome

in South Australia
  2013



October 2015 
Pregnancy Outcome in South Australia 2013 
  SA Health

Address: 
Pregnancy Outcome (Statistics) Unit 
Epidemiology Branch 
SA Health, Government of South Australia 
Citi Centre Building 
11 Hindmarsh Square  
Adelaide 5000 
South Australia

Postal Address: 
Pregnancy Outcome (Statistics) Unit 
SA Health, Government of South Australia  
PO Box 6, Rundle Mall 
Adelaide  5000 
South Australia

Telephone: (08) 8226 6382 
Fax: (08) 8226 6291

Web: www.sahealth.gov.au 

E-mail: Pregnancy.Stats@health.sa.gov.au

ISSN 0819-3835 
ISBN 978-1-74243-807-8

Suggested citation: Scheil W, Jolly K, Scott J, Catcheside B, Sage L, Kennare R. Pregnancy Outcome in South Australia 2013. 
Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2015.



Pregnancy Outcome in  
South Australia 2013

Wendy Scheil
Kerry Jolly
Joan Scott

Britt Catcheside
Leonie Sage

Robyn Kennare

October 2015 

Pregnancy Outcome Unit 
SA Health



Staff
Wendy Scheil  Head/Senior Medical Consultant

Joan Scott  Senior Midwife

Leonie Sage  Senior Midwife, Abortion Statistics 

Maureen Fisher  Administrative Officer

Judith Thompson  Administrative Officer

Kerry Jolly  Midwife

Robyn Kennare  Senior Midwife, Maternal, Perinatal &amp; Infant Mortality Committee

Acknowledgements
We would like to thank all midwives and nurses in South Australia who completed and submitted the Supplementary Birth 
Records on which the perinatal data collection is based. We thank them also for responding so efficiently to our queries.

We would also like to express our sincere thanks to the following:

 &gt; doctors who notified births with congenital abnormalities and those who notified terminations of pregnancy;

 &gt; the pathology departments of teaching hospitals for autopsy information;

 &gt; the Genetics and Molecular Pathology Directorate, Women s and Children s Hospital, for cytogenetics reports;

 &gt; the Births, Deaths and Marriages Registration Division for data and perinatal death certificates;

 &gt; the Coroner s Office for Coroner s findings and autopsy reports;

 &gt; Kevin Priest of the Health Statistics Unit for his assistance in programming and provision of perinatal data to the 
National Perinatal Statistics Unit and in data linkage;

 &gt; Graeme Tucker, Kamalesh Venugopal, Britt Catcheside and Anh Minh Nguyen of the Health Statistics Unit for 
assistance with responding to data requests and in data linkage;

 &gt; Alison Scott for assisting with data entry;

 &gt; Maureen Fisher and Britt Catcheside for the graphics; 

 &gt; Fred Calabrese of the Epidemiology Branch for his assistance with the import of electronically transferred data from 
the Women s and Children s Hospital;

 &gt; Bridget Milanowski from Information Systems, Standards &amp; Quality Unit for updating the maps; and

 &gt; Media and Communications Branch of SA Health for publication.

Pregnancy Outcome in South Australia 2013page 2

Acknowledgements



Contents

Acknowledgements ........................................................................................................2

Executive Summary .......................................................................................................10

1. Numbers and fertility rates ........................................................................................................................10

2. Place of birth ............................................................................................................................................10

3. Teenage women .......................................................................................................................................10

4. Older women and first time mothers ........................................................................................................10

5. Country of birth and race .........................................................................................................................10

6. Smoking during pregnancy and Body Mass Index .....................................................................................10

7. Antenatal care and length of stay .............................................................................................................11

8. Aboriginal women and babies ..................................................................................................................11

9. Procedures ...............................................................................................................................................11

10. Method of birth ......................................................................................................................................11

11. Multiple births ........................................................................................................................................11

12. Abortions ...............................................................................................................................................12

13. Perinatal mortality ..................................................................................................................................12

I.  Introduction ...........................................................................................................13

1. The Perinatal Statistics Collection ..............................................................................................................13

2. The Abortion Statistics Collection .............................................................................................................13

II.  Mothers and Babies: Characteristics &amp; Outcomes ...............................................14

1. Place of residence of mother ....................................................................................................................14

2. Place of birth of baby ...............................................................................................................................15

3. Maternal and baby race ............................................................................................................................20

4. Maternal age ............................................................................................................................................21

5. Country of birth .......................................................................................................................................23

6. Marital status and type of patient .............................................................................................................25

7. Occupation of father and mother .............................................................................................................26

8. Previous pregnancy outcomes ...................................................................................................................27

9a. Gestation at first antenatal visit ...............................................................................................................28

9b. Body Mass Index (BMI) ............................................................................................................................28

9c. Antenatal visits .......................................................................................................................................29

9d. Type of antenatal care ............................................................................................................................29

10. Smoking .................................................................................................................................................30

11. Medical conditions .................................................................................................................................31

12. Obstetric complications ..........................................................................................................................31

Pregnancy Outcome in South Australia 2013 page  3

Contents



13. Procedures performed in current pregnancy ............................................................................................32

14a. Onset of labour ....................................................................................................................................32

14b. Reasons for induction of labour ............................................................................................................33

15a. Presentation and method of birth .........................................................................................................34

15b. Reason for caesarean section ................................................................................................................36

16. Complications of labour and birth and perineal status after birth ............................................................37

17. Fetal monitoring during labour ...............................................................................................................38

18. Analgesia for labour and anaesthesia for birth ........................................................................................38

19. Postnatal length of stay of women .........................................................................................................39

20. Sex of baby ............................................................................................................................................40

21. Birthweight and gestation ......................................................................................................................40

22. Birth injuries ...........................................................................................................................................41

23. Treatment given in neonatal period .........................................................................................................41

24. Level of care utilised ...............................................................................................................................41

25. Length of stay of babies .........................................................................................................................42

26. Congenital anomalies .............................................................................................................................42

27. Multiple births ........................................................................................................................................43

28. Perinatal mortality ..................................................................................................................................45

29. Home births ...........................................................................................................................................47

30. Birthing unit births ..................................................................................................................................49

III. Terminations of Pregnancy ...................................................................................51

1. Numbers and rates ...................................................................................................................................51

2. Age of women .........................................................................................................................................52

3. Place of residence and place where termination performed .......................................................................54

4. The reason for termination .......................................................................................................................55

5. Gestation, method and complications .......................................................................................................55

6. Previous terminations. Total termination of pregnancy rate and total first termination of pregnancy rate ...57

IV. Obstetric Profiles by Hospital Category ...............................................................59

V. Clinical and Maternity Performance Indicators ...................................................68

1. Clinical indicators .....................................................................................................................................68

1: Smoking in pregnancy ...........................................................................................................................68

2: Antenatal care in the first trimester for all women giving birth ...............................................................69

3: Episiotomy for women having their first baby and giving birth vaginally .................................................69

4: Apgar score of less than 7 at 5 minutes for births at or after term .........................................................70

5: Induction of labour for selected primiparae ...........................................................................................70

Pregnancy Outcome in South Australia 2013page 4

Contents



6: Caesarean section for selected primiparae .............................................................................................70

7: Normal (non-instrumental) vaginal birth for selected primiparae ............................................................70

8: Instrumental vaginal birth for selected primiparae ..................................................................................71

9: General anaesthetic for women giving birth by caesarean section ..........................................................71

10: Small babies among births at or after 40 weeks gestation.....................................................................71

2. Maternity performance indicators, hospitals with at least 550 births per year ............................................72

VI. Trends in Perinatal Statistics in South Australia, 1981-2013 ...............................76

Trends in Perinatal Statistics in South Australia (SA), 1981   2013 .................................................................79

VII. Summary Statistics for 2013 ..................................................................................82

1. Number of births ......................................................................................................................................82

2. Place of birth ............................................................................................................................................82

3. Sex ...........................................................................................................................................................82

4. Plurality and condition at birth ..................................................................................................................82

5. Race of women ........................................................................................................................................82

6. Obstetric interventions in 20,338 women who gave birth .........................................................................83

7. Low birthweight (&lt;2,500g) .......................................................................................................................83

8. Congenital anomalies ...............................................................................................................................83

9. Perinatal mortality rates (numbers of deaths in parentheses) .....................................................................83

10. Terminations of pregnancy ......................................................................................................................83

References .....................................................................................................................84

Publications ...................................................................................................................85

Annual Reports .............................................................................................................................................85

Other reports/papers ....................................................................................................................................85

1. Birth defects 85

2. Termination of pregnancy 88

3. Perinatal epidemiology 88

4. Perinatal mortality 91

5. Caesarean section 91

Appendix 1: Definitions ................................................................................................92

Appendix 2: 2013 Supplementary Birth Record Form .................................................96

Appendix 3: Congenital Abnormality Form ................................................................97

Pregnancy Outcome in South Australia 2013 page  5

Tables



Tables

Table 1:  Births and crude birth rate by ASGS regions ................................................................................14

Table 2:  Total births notified in 2013, by place of birth and plurality, South Australia ................................15

Table 3a:  Hospital births by perinatal service delineation of hospital ...........................................................18

Table 3b:  Hospital births by race and hospital .............................................................................................19

Table 4a:  Race of women who gave birth ..................................................................................................21

Table 4b:   Race and birthplace category of women who gave birth ............................................................21

Table 4c:  Age and race of women who gave birth .....................................................................................22

Table 4d:  Age-specific fertility rates ............................................................................................................23

Table 5a:  Country of birth, major groups ...................................................................................................23

Table 5b:  Specified country of birth ............................................................................................................23

Table 6a:  Marital status and age ................................................................................................................25

Table 6b:  Type of patient and marital status ...............................................................................................25

Table 7:  Occupation of father and mother ................................................................................................26

Table 8a:  Parity by race, women who gave birth ........................................................................................27

Table 8b:  Previous pregnancy outcomes (multigravidae only) ......................................................................27

Table 9a:  Gestation at first antenatal visit ...................................................................................................28

Table 9b: BMI of women who gave birth ....................................................................................................28

Table 9c:  Antenatal visits by race, women who gave birth ..........................................................................29

Table 9d:  Type of antenatal care .................................................................................................................29

Table 10a:  Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women ................30

Table 10b:  Average number of tobacco cigarettes smoked per day in the second half of pregnancy,  

non-Aboriginal and Aboriginal women .......................................................................................30

Table 11:  Medical conditions in current pregnancy .....................................................................................31

Table 12:  Frequency of some obstetric complications .................................................................................31

Table 13:  Procedures performed in current pregnancy ................................................................................32

Table 14a: Onset of labour ...........................................................................................................................32

Table 14b:  Method of induction of labour ....................................................................................................32

Table 14c:  Augmentation of labour after spontaneous onset .......................................................................33

Table 15a:  Method of birth ..........................................................................................................................34

Table 15b:  Method of birth by presentation .................................................................................................35

Table 15c:  Method of birth in breech presentation, by plurality ....................................................................35

Table 16:  Frequency of some complications of labour and birth ..................................................................37

Table 17a:  CTG performed during labour .....................................................................................................38

Pregnancy Outcome in South Australia 2013page 6

Tables



Table 17b:  Fetal scalp pH taken during labour ..............................................................................................38

Table 18a:  Analgesia for labour ....................................................................................................................38

Table 18b:  Anaesthesia for birth ...................................................................................................................39

Table 19a:  Postnatal length of stay by type of patient ..................................................................................39

Table 19b:  Average postnatal length of stay by type of patient &amp; type of birth .............................................39

Table 20: Sex of baby .................................................................................................................................40

Table 21:  Birthweight distribution of all births ............................................................................................40

Table 22:  Birth injuries ................................................................................................................................41

Table 23:  Neonatal treatment given, all live births ......................................................................................41

Table 24:  Level of nursery care utilised by birthweight, all live births ...........................................................41

Table 25:  Length of stay of liveborn babies in hospital ................................................................................42

Table 26:  Selected congenital abnormalities notified to the perinatal statistics collection ............................43

Table 27a: Birthweight by plurality ...............................................................................................................44

Table 27b: Gestation at birth by plurality ......................................................................................................44

Table 27c:  Perinatal outcome by plurality .....................................................................................................44

Table 28a:  Perinatal mortality by birthweight ...............................................................................................45

Table 28b: Perinatal mortality by gestational age at birth ..............................................................................46

Table 28c:  Perinatal mortality (all births of specified birthweight/gestation) ..................................................46

Table 28d:  Perinatal mortality by race, all births ............................................................................................47

Table 29:  Planned home births by age of women .......................................................................................47

Table 30:  Method of birth in planned home births .....................................................................................48

Table 31:  Birthweight distribution of planned home births .........................................................................48

Table 32:  Perinatal outcome in planned home births ..................................................................................48

Table 33: Planned birthing unit births by age of women .............................................................................49

Table 34: Method of birth in planned birthing unit births ...........................................................................49

Table 35:  Birthweight distribution of planned birthing unit births ...............................................................50

Table 36: Perinatal outcome in planned birthing unit births ........................................................................50

Table 37:  Termination of pregnancy rate per 1,000 women aged 15-44 years, 1970-2013 .........................51

Table 38:  Terminations of pregnancy by age ...............................................................................................52

Table 39:  Termination of pregnancy and live birth rates and termination of pregnancy proportions by age, 

South Australia, 2013 .................................................................................................................53

Table 40:  Terminations by place of residence ..............................................................................................54

Table 41:  Terminations by hospital category ...............................................................................................54

Table 42:  Terminations by category of doctor .............................................................................................55

Table 43:  Reason for termination for fetal reasons ......................................................................................55

Pregnancy Outcome in South Australia 2013 page  7

Tables



Table 44a:  Women with previous terminations by age..................................................................................56

Table 44b:  Calculation of total induced abortion rate (TAR) ..........................................................................56

Table 45a:  Women with previous terminations by age..................................................................................57

Table 45b:  Calculation of total induced abortion rate (TAR) ..........................................................................58

Table 45c:  Calculation of total first induced abortion rate (TFAR)  .................................................................58

Table 46:  Obstetric profiles by hospital category, South Australia, 2013: live births and stillbirths  

of &gt;=400g or &gt;=20 weeks gestation ...........................................................................................61

Table 47: Socio-demographic aspects of perinatal statistics, 1981 and 2003   2013 ...................................77

Table 48:  Obstetric aspects of perinatal statistics, 1981 and 2002   2013 ...................................................78

Figures

Figure 1a: Map showing SA hospitals with obstetric beds in 2013 ...............................................................16

Figure 1b: Map showing Central Regions of SA ...........................................................................................17

Figure 2: Distribution of hospital births by hospital category ......................................................................18

Figure 3: Age and race of women who gave birth .....................................................................................22

Figure 4: Reasons for induction of labour ..................................................................................................33

Figure 5a: Method of birth, women who gave birth ....................................................................................34

Figure 5b: Reason for caesarean section ......................................................................................................36

Figure 5c:  Reason for elective caesarean section ..........................................................................................36

Figure 5d: Reason for emergency caesarean section ....................................................................................37

Figure 6: Perinatal mortality rate by birthweight, all births .........................................................................45

Figure 7:  Termination of pregnancy rate in South Australia, 1970-2013 .....................................................51

Figure 8a: Termination of pregnancy and live births by age ..........................................................................53

Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2013 ........54

Figure 9: Percentage of Aboriginal women by hospital category ................................................................62

Figure 10: Percentage of women with &lt;7 antenatal visits by hospital category .............................................62

Figure 11: Percentage of teenage women by hospital category ....................................................................62

Figure 12: Percentage of women 35 years or more by hospital category ......................................................63

Figure 13: Percentage of single women by hospital category .......................................................................63

Figure 14: Percentage of women with 4 or more prior livebirths by hospital category ..................................63

Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category .......................64

Figure 16: Percentage of women with obstetric complications by hospital category .....................................64

Figure 17:  Percentage of women with complications during labour or birth by hospital category ................64

Figure 18: Percentage of women with induction of labour by hospital category ...........................................65

Pregnancy Outcome in South Australia 2013page 8

Figures



Figure 19: Percentage of women having epidural analgesia by hospital category .........................................65

Figure 20: Percentage of breech births by hospital category .........................................................................65

Figure 21: Percentage of emergency caesarean sections by hospital category ...............................................66

Figure 22: Percentage of elective caesarean sections by hospital category ....................................................66

Figure 23: Percentage of total caesarean sections by hospital category ........................................................66

Figure 24: Percentage of births with birthweight below 2,500g by hospital category ...................................66

Figure 25: Percentage of births with gestation less than 37 weeks by hospital category ...............................67

Figure 26: Percentage of births with prolonged hospitalisation by hospital category .....................................67

Figure 27: Percentage of live births requiring neonatal intensive care by hospital category ...........................67

Figure 28: Percentage of births with birth defects by hospital category ........................................................67

Figure 29a: Induction of labour for selected primiparae, SA hospitals with &gt;=550 births per year ..................73

Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with &gt;=550 births per year .............73

Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first) caesarean 

section &amp; no intervening births, SA hospitals with &gt;=550 births per year .....................................74

Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals with 

&gt;=550 births per year .................................................................................................................74

Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital 

abnormality, SA hospitals with &gt;=550 births per year ..................................................................74

Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=550 births 

per year,......................................................................................................................................75

Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=550 births 

per year, 2008-2013 ...................................................................................................................75

Figure 30.1: Percentage of teenage women among women giving birth in SA ..............................................79

Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA .......................79

Figure 30.3: Percentage of primiparous women aged 35 years and over in SA ..............................................79

Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA ..............80

Figure 30.5: Percentage of women never married and with no de facto partner among women giving  

birth in SA ..................................................................................................................................80

Figure 30.6: Percentage of multiple births among births in SA ......................................................................80

Figure 30.7 Percentage of low birthweight babies among births in SA ...........................................................81

Figure 30.8: SA standardised perinatal mortality ratio (SPMR)........................................................................81

Pregnancy Outcome in South Australia 2013 page  9

Figures



Executive Summary
This report on Pregnancy Outcome in South Australia for 2013 provides statistics derived mainly from the South 
Australian perinatal statistics collection of births. These are notified by hospital and homebirth midwives and neonatal 
nurses. For a more complete picture of pregnancy outcome, some statistics from the abortion statistics collection 
are also included. More statistics on abortions in the state in 2013 are available in the Eleventh Annual Report of the 
Abortion Reporting Committee. Comparisons of selected pregnancy characteristics and outcomes are provided for 
six different hospital categories in the state. Individual hospital reports (Pregnancy and Neonatal Care Bulletins) with 
these comparisons made in greater detail are provided to hospitals in the state with at least 100 births per year. Group 
reports are provided for hospitals with smaller numbers of births. Comparisons of maternity performance indicators 
are also provided for hospitals with at least 550 births per year.

1. Numbers and fertility rates
The number of births notified in South Australia in 2013 was 20,263, which was 403 less than the previous year. The 
number of women who gave birth was 19,925. The total fertility rate was 1.85 live births per woman, lower when 
compared with that of 2012 which was 1.91.The  2012 rate was the same as in 2007 and 2008 and  represented the 
highest rate in the past decade. 

2. Place of birth
Compared to 2012, the numbers of births increased at all metropolitan teaching hospitals. Births increased at one of 
the metropolitan private hospitals while they decreased at three with one remaining steady. 1,291women (6.4%) gave 
birth in birthing units in teaching hospitals and 107(0.6%) had planned home births.

3. Teenage women
666 teenage women gave birth, accounting for 3.3% of women who gave birth, and 622 teenage women had 
terminations of pregnancy, accounting for 13.3% of terminations. In 2013, the proportion of  known  pregnancies 
terminated was 48% for teenagers compared with 19% for women of all ages. The teenage pregnancy rate declined 
in the 1970s and 1980s, but increased in the early 1990s. It declined again after 1996. The teenage pregnancy rate in 
2013 of 25.3 per 1,000 women aged 15-19 years, was the lowest rate recorded since 1970.

4. Older women and first time mothers
The mean age of women giving birth increased from 26.6 years in 1981 to 29.8 years in 2013, and, among first time 
mothers, from 24.4 years to 28.2 years. The proportion of women aged 35 years or more increased from 4.6% in 
1981 to a high of 21.1% in 2009 and was 19.8% in 2013. Among first time mothers, this proportion increased from 
1.2% to 12.8% in 2009 and was 12.4% in 2013. As in the previous decade, more women gave birth in the 30-34 
years than in the 25-29 years age group. 

5. Country of birth and race
Seventy-seven percent of women who gave birth in 2013 were Australian-born.  Of women born overseas who 
gave birth, the largest proportions came from India (4% of women), the United Kingdom and Ireland (2.5%), China 
(2.2%), Vietnam (1.2%), the Philippines (1.%), New Zealand (0.9%) and Sudan (0.7%), Afghanistan (0.6%), Pakistan 
(0.5%) and Cambodia and Malaysia (0.4%). Of the women who gave birth in the state in 2013, 12.0% (2,394 
women) were Asian, compared with 2% in 1981. They gave birth mainly in teaching hospitals.

6. Smoking during pregnancy and Body Mass Index
The proportion of women smoking at the first antenatal visit has declined steadily from 25% in 1998 to 11.1% in 
2013. Additionally 3.3% of women had quit smoking before the first antenatal visit.

Statistics on Body Mass Index were available for 81% of women who gave birth in 2013 (an improvement from 42% 
in 2007), and show that 42.3% of all women giving birth were overweight, including 11.3% classified as obese and 
8.2% severely or morbidly obese.

Pregnancy Outcome in South Australia 2013page 10

Executive Summary



7. Antenatal care and length of stay
Week of gestation at the first antenatal visit was reported for 95% of women who gave birth, and show that 81% 
of these women attended for antenatal care within the first 14 weeks of pregnancy. Ninety-nine percent of women 
attended at least one antenatal visit. Of those women for whom the number of antenatal visits was reported, 91% 
of women attended seven or more antenatal visits. Although many women had more than one type of antenatal 
care, the most common types used were hospital clinics (42%), obstetricians in private practice (27%) and general 
practitioners (22.3%). Twenty-seven percent of women were private patients. The median length of stay of women 
after a birth was three days; it was two days for those who had a vaginal birth and four days for those who had a 
caesarean section.  It was both two days longer among private patients for vaginal births and for caesarean births.

8. Aboriginal women and babies
717 Aboriginal women gave birth in South Australia in 2013, accounting for 3.6% of all women who gave birth in 
the state. Fourteen percent of Aboriginal women were teenagers (compared with 2.9% of non-Aboriginal women). 
Of the Aboriginal women for whom week of gestation at the first antenatal visit was reported, 53% attended for 
antenatal care within the first 14 weeks of pregnancy (compared with 82% of non-Aboriginal women). Of the 
Aboriginal women for whom the number of antenatal visits was reported, 67% attended at least seven antenatal 
visits during pregnancy (compared with 89% of non-Aboriginal women). In 2013, at the first antenatal visit, 45% of 
Aboriginal women reported that they smoked, compared with 49% in 2012, while in non-Aboriginal women this 
proportion was 9.8%. In 2013, the proportion of preterm births (&lt;37 weeks gestation) was 18% among babies of 
Aboriginal women compared with 9.5% among babies of non-Aboriginal women. Among live born babies (excluding 
terminations of pregnancy), the proportions of low birthweight babies (&lt;2,500g) were 14.8% and 6.9% respectively. 
The perinatal mortality rate of babies of Aboriginal women was 15.1 per 1,000 births in 2013 compared with 8.8 per 
1,000 births for births to non-Aboriginal women.

For the first time in 2012, the Indigenous status of the baby was also collected independently of the mother. There 
were 952 Indigenous babies, representing 4.8% of all babies born in 2013. They comprised 904 (95%) Aboriginal, 17 
(1.8%) Torres Strait Islander and 31 (3.3%) Aboriginal and Torres Strait Islander.

9. Procedures
Ninety-eight percent of women who gave birth had an ultrasound examination; 33% had labour induced while 
another 18% had spontaneous labour augmented; epidurals were used for pain relief during labour for 31% of 
women, and 13% had an episiotomy (20% of women who gave birth vaginally). The main reasons for induction of 
labour were prolonged pregnancy (17%), hypertension (15%), diabetes or gestational diabetes (9.5%), poor fetal 
growth (8%) and premature rupture of membranes (9.5%). Forty-five percent of inductions of labour were performed 
for other than defined indications.

10. Method of birth
Fifty-four percent of women had normal spontaneous vaginal births. Six percent gave birth by ventouse and another 
5.6% by forceps (compared with 1% and 15% respectively in 1981). In 2013 the proportion of women giving birth 
by caesarean section was 34%, a proportion which has been relatively stable for several years. Of those who had 
previously given birth, 31% had previously had a caesarean section. Only 15.6% of women had a vaginal birth 
following a previous first caesarean without intervening births, compared with 30% in 1998. The main reasons 
given for caesarean section were previous caesarean section (36%), failure to progress in labour or cephalopelvic 
disproportion (27%), fetal distress (15%) and malpresentation (11%). 

11. Multiple births
Multiple births accounted for 3.3% of births; women with twins or triplets accounted for 1.6% of women who gave 
birth in 2013. These proportions increased in the 1980s and 1990s as a result of the use of assisted conception and 
the increasing proportion of older women, who have higher rates of multiple pregnancies than younger women. The 
peak proportion of multiple births was recorded in 2002 and 2003 (3.6%). The subsequent decline in the proportion 
of multiple births was probably related to the increasing use of single embryo transfer in assisted conception practice.

Pregnancy Outcome in South Australia 2013 page  11

Executive Summary



12. Abortions
4,681 terminations of pregnancy were notified, 84 fewer than in 2012. The induced abortion rate was 14.4 per 
1,000 women aged 15-44 years, compared with 14.7 per 1,000 women aged 15-44 years in 2012. It has declined 
significantly since 2001, when it was 17.7 per 1,000 women. Approximately 97% of terminations were performed 
in metropolitan public hospitals, including the Pregnancy Advisory Centre, and 77% were performed by doctors 
in family advisory clinics in these hospitals. Ninety-one percent of terminations were performed within the first 14 
weeks of pregnancy and 2.0% (94) were performed at or after 20 weeks gestation. Fifty percent of terminations 
performed at or after 20 weeks gestation were for fetal reasons. Approximately 19% of reported pregnancies ended 
as terminations in 2013.

13. Perinatal mortality
The perinatal mortality rate for all births in 2013 was 9.0 per 1,000 births, the stillbirth rate 6.8 per 1,000 births and 
the neonatal mortality rate 2.2 per 1,000 live births. For international comparison, the World Health Organisation 
recommends including only stillbirths of at least 1,000g birthweight (or 28 weeks gestation if birthweight unavailable) 
and early neonatal deaths within the first 7 days of life (instead of 28 days) in calculating the perinatal mortality rate. 
This rate for international comparison for South Australia for 2013 was 2.3 per 1,000 births, with an early neonatal 
mortality rate of 0.5per 1,000 live births. 

Pregnancy Outcome in South Australia 2013page 12

Executive Summary



I. Introduction
This report summarises the statistics for 2013 from the South Australian Perinatal Statistics Collection and the South 
Australian Abortion Statistics Collection, both of which are held in the Pregnancy Outcome Unit. Some definitions 
used by the Unit are provided in Appendix 1. Guidelines1 with some of these definitions are issued to all South 
Australian obstetric units to promote the uniform completion of forms.

1. The Perinatal Statistics Collection
This collection utilises notifications of births in South Australia made by hospital and homebirth midwives and hospital 
neonatal nurses on the Supplementary Birth Record Form (SBR - Appendix 2). The SBRs are checked manually for 
completeness and data discrepancies and then go through a series of automated validation procedures during data 
entry.1

Information on congenital abnormalities detected at birth or in the neonatal period (within 28 days of birth) is 
provided by doctors using the Congenital Abnormality Form (Appendix 3). Few statistics on birth defects are included 
in this report as these are reported annually by the South Australian Birth Defects Register at the Women s and 
Children s Hospital.2 The Register complements statistics on birth defects from the perinatal and abortion statistics 
collections with statistics on birth defects detected and notified after discharge from the birth hospital up to the 
child s fifth birthday.

Perinatal data are provided under legislation, the South Australian Health Care Regulations 2008, Part 5 Pregnancy 
outcome data and statistics. The South Australian Perinatal Statistics Collection includes all births occurring in South 
Australia, including those to women who normally reside interstate, mainly in New South Wales near the South 
Australian border and in the Northern Territory. Births of South Australian residents which occur in other states are not 
included. The perinatal data have been collected since 1981, but there have been changes in the data items collected 
over the years.

Perinatal death certificates are obtained from the Births, Deaths and Marriages Registration Division, chromosome 
analysis reports from the Genetics and Molecular Pathology Directorate  at Women s and Children s Hospital, autopsy 
reports from pathology departments and Coroner s autopsy reports and findings from the Coroner s Office. All these 
are linked with the SBRs to provide more complete information on births and deaths. All maternal, perinatal and 
infant deaths in the state are reviewed by the Maternal, Perinatal and Infant Mortality Committee and details of 
these are reported in the annual report of the Committee entitled  Maternal, Perinatal and Infant Mortality in South 
Australia 2013. 3

2. The Abortion Statistics Collection
Notifications made by doctors of medical terminations of pregnancy under the Criminal Law Consolidation (Medical 
Termination of Pregnancy) Regulations 2012, are included in this collection. This collection commenced in 1970, when 
specific abortion legislation was introduced under the Criminal Law Consolidation Act. Termination of pregnancy 
became legal in the state if performed in a prescribed hospital by a medical practitioner for a woman who has been 
resident at least two months in the state. The practitioner and another medical practitioner must have examined 
the woman and formed the opinion that the continuation of the pregnancy would involve greater risk to her life 
or greater risk of injury to her physical or mental health than if the pregnancy were terminated; or that there is a 
substantial risk that if the pregnancy were not terminated and the child were born, the child would suffer from 
such physical or mental abnormalities as to be seriously handicapped. A termination may not be performed on a 
woman who is pregnant with a child  capable of being born alive  unless it is performed to save the woman s life. 
The legislation states that evidence that a woman has been pregnant for a period of 28 weeks or more is prima facie 
proof that she was pregnant with a child that was capable of being born alive.

Pregnancy Outcome in South Australia 2013 page  13

Introduction



II. Mothers and Babies: Characteristics &amp; Outcomes
The births in 2013 in South Australia described in this report include live births, stillbirths and terminations of 
pregnancy of at least 400g birthweight or 20 weeks gestation.  Fifty births of less than 400g birthweight have been 
included, consisting of 45 stillbirths and five live births. The five live births were born at 20-28 weeks gestation and all 
died in the neonatal period. SBRs were received for all 20,263 births reported by hospital and home birth midwives 
in their monthly notification lists. These comprised 20,125 live births and 138 stillbirths. The number of women who 
gave birth was 19,925, 413 less women than in 2012. Findings relating to Aboriginal women and babies in the text of 
this report have been italicised for easy identification, in accordance with the request of the Aboriginal Health Council 
of South Australia.

1. Place of residence of mother
This table uses the ABS Statistical Geographical Boundaries (ASGS 2013), with SA4 boundaries for the four Adelaide 
Metropolitan Regions, and SA3 boundaries to present the nine non metropolitan components in South Australia. The 
distribution of births according to the mother s place of residence by these Regions is provided in Table 1 together 
with the estimated resident population and crude birth rate. The crude birth rate in 2013 for South Australia was 12 
per 1,000 population. It was lowest in the Fleurieu   Kangaroo Island, and Adelaide-Central and Hills regions. It was 
highest in the Adelaide - North Region and was also high in Eyre Peninsula and South West, and Outback   North and 
East Regions.

Table 1: Births and crude birth rate by ABS Statistical Geographical Boundaries (ASGS 2013) regions,  
South Australia, 2013

ASGS 2013 
(Mother s residence)

Total births Live births
Estimated resident 

population, June 
30, 2013+

Crude birth 
rate per 1,000 

population
Number Percent Number Number

Adelaide - Central and Hills 2,920 14.4 2,894 292,814 9.9

Adelaide - North 6,068 29.9 6,037 413,356 14.6

Adelaide - South 4,112 20.3 4,077 356,282 11.4

Adelaide - West 2,682 13.2 2,664 229,214 11.6

Barossa 367 1.8 367 34,308 10.7

Lower North 237 1.2 233 22,535 10.3

Mid North 299 1.5 296 27,510 10.8

Yorke Peninsula 250 1.2 249 24,835 10.0

Eyre Peninsula and South West 790 3.9 787 58,169 13.5

Outback - North and East 377 1.9 375 29,534 12.7

Fleurieu - Kangaroo Island 401 2.0 401 48,572 8.3

Limestone Coast 777 3.8 772 64,703 11.9

Murray and Mallee 809 4.0 804 68,995 11.7

Interstate 174 0.9 169 na na

Total 20,263 100.0 20,125 1,670,827 12.0

+ Australian Bureau of Statistics. Population estimates by age and sex, South Australia, 2013. Canberra: ABS, 2013  
(Catalogue No 3235.0).

na: not applicable  

Pregnancy Outcome in South Australia 2013page 14

Mothers and Babies



2. Place of birth of baby
Of the 20,263 births in 2013, 114 (0.6%) were home births and of those, 107 were planned homebirths. The 
remaining 20,149 births occurred in hospitals or in 91cases, before arrival at hospitals into which the women had 
been booked. These 91  Born Before Arrival  (BBA) births have been included in the statistics for those hospitals. 
The distribution of births by place of birth (home or hospital) and plurality is provided in Table 2. Locations of South 
Australian hospitals with obstetric beds in 2013 are provided in Figures 1a and 1b.

Table 2: Total births notified in 2013, by place of birth and plurality, South Australia

Condition at 
birth

Home births Hospital births
Total

Singleton Twin Singleton Twin Triplet

Live birth 114 - 19,348 636 27 20,125

Stillbirth 0 - 134 4 0 138

Total births 114 - 19,482 640 27 20,263

Of the 20,149 hospital births, 80.5% occurred in metropolitan hospitals (teaching and private) and 19.5% in country 
hospitals. This distribution is summarised in Table 3a and Figure 2. Table 3b provides the numbers of births and 
women by race in individual hospitals. Metropolitan hospitals are listed in order of number of births and country 
hospitals in alphabetic order within their Perinatal Service Delineation and category of number of births. Fifty-eight 
percent of hospital births in South Australia in 2013 occurred in metropolitan teaching hospitals. Maternity and 
neonatal services at SA hospitals are delineated according to six levels of service, as defined in the policy,  Standards 
for Maternal and Neonatal Services in SA, 2010 .4  The Women s and Children s Hospital is defined as providing Level 
5 maternity services and Level 6 neonatal services, as it provides a high risk pregnancy service and neonatal intensive 
care, but has no maternity intensive care facility on site. The Lyell McEwin Hospital provides Level 6 maternity services 
and Level 5 neonatal services with maternity intensive care services and special care neonatal services. Flinders Medical 
Centre provides Level 6 maternity and neonatal services with both maternity and neonatal intensive care services. All 
the metropolitan private maternity hospitals have special care nurseries, as do Mt Gambier and Port Augusta hospitals. 

Compared with 2012, the total number of births decreased overall at the three metropolitan teaching hospitals. 
The total number of births in metropolitan private hospitals also decreased. Ashford and North Eastern Community 
showed an increase, whilst small decreases were seen at Burnside, Calvary and Flinders Private.

The total number of births in country hospitals decreased slightly. In the Level 4:4 country centres, births decreased 
at Mount Gambier, while births at Port Augusta increased. Increases also occurred at the majority of hospitals with 
more than 100 births per year, e.g. Gawler Health Service, Loxton, Mount Barker Murray Bridge, Naracoorte and 
the Northern Yorke Peninsula Regional Health Service (Wallaroo). Small decreases were seen at Riverland General 
Hospital (Berri), Port Lincoln, Barossa Health (Tanunda), and Whyalla. At smaller country centres with &lt;100 births per 
year, births increased only at Waikerie. Decreases were seen at Lower North Health Centre (Clare), Mid North Health 
(Jamestown), Kangaroo Island, Millicent, South Coast District (Victor Harbor) and Southern Flinders Health (Crystal 
Brook). Numbers remained relatively constant at Ceduna and Kapunda.

Pregnancy Outcome in South Australia 2013 page  15

Mothers and Babies





Figure 1a: South Australian hospitals with obstetric beds in 2013

V

(!

(!

(!

(!

(!

(!

(!

(!

(!

!

!

!

!

!

!

!

!

OUTBACK - NORTH AND EAST

EYRE PENINSULA 
AND SOUTH WEST

MURRAY 
AND MALLEE

LIMESTONE COAST

MID NORTH

LOWER NORTH

YORKE PENINSULA

FLEURIEU - KANGAROO ISLAND

Quorn

Clare

Berri

Ceduna

Loxton

Whyalla

Wallaroo Waikerie

Jamestown

Millicent

Kingscote

Port Pirie

Naracoorte

Port Lincoln

Port Augusta

Mount Gambier

Murray Bridge

Crystal Brook

0 150 30075

Kilometres

" &gt; 2000 births per annum

# 1000-2000 births per annum

V 450 - 999 births per annum

(! 100 - 449 births per annum

! &lt; 100 births per annum

See Figure 1b for
Central Regions

 

Pregnancy Outcome in South Australia 2013page 16

Mothers and Babies



Figure 1b: Hospitals with obstetric beds in 2013, Central Region of SA 

"

""

"

#
#

V
V

V

V

(!

(!

(!

!

!

ADELAIDE - NORTH

ADELAIDE - SOUTH

Kapunda

Gawler Health Service

Lyell McEwin

FMC

Tanunda

W&amp;CH

SCDH 
(Victor Harbor)

Ashford
BWMH

Calvary

Flinders Private

Mt Barker

NECH

FLEURIEU - KANGAROO ISLAND

BAROSSA

ADELAIDE - CENTRAL 
AND HILLS

ADELAIDE - WEST

0 10 205

Kilometres

" &gt; 2000 births per annum

# 1000-2000 births per annum

V 450 - 999 births per annum

(! 100 - 449 births per annum

! &lt; 100 births per annum

Pregnancy Outcome in South Australia 2013 page  17

Mothers and Babies



Table 3a: Hospital births by Perinatal Service Delineation, South Australia, 2013

Hospital category Number of births Percent hospital births

Metropolitan teaching 11,609 57.6

   Women s &amp; Children s Hospital   (W&amp;CH) (4,891) (24.3)

   Flinders Medical Centre (FMC) (3,384) (16.8)

   Lyell McEwin Hospital (LMH) (3,333) (16.5)

Metropolitan private 4,622 22.9

Country 3,918 19.5

   Level 4:4 (860) 4.3

   Level 3:3&gt;100 births  per annum (2,595) 12.9

   Level 3:3&lt;100 births per annum (453) 2.3

   Other Country (10) 0.0

Total 20,149 100.0

Figure 2: Distribution of hospital births by hospital category, South Australia, 2013 (n=20,149)

b

16.8%

0 10 20 30 40 50 60 70

Percentage of hospital births

19.5%

22.9%

57.6%

a Ashford 7.2%
b Burnside 5.8%
c Calvary 3.9%
d Flinders Private 2.6%
e North Eastern Community 3.4%

r Mt Gambier 2.8%
s Port Augusta 1.5%
t Gawler 2.8%
u Mount Barker 1.9%
v Port Lincoln 1.5%
w Murray Bridge 1.2%
x Whyalla 1.3%
y Other country hospitals with &gt;100 births per year 4.2%
z Hospitals with &lt;100 births per year 2.3%

W&amp;CH LMHFMC

e

u v w

24.3% 16.5%

a c

r s x y zt

d

Pregnancy Outcome in South Australia 2013page 18

Mothers and Babies



Table 3b: Hospital births in South Australia in 2013 by race and hospital*

Hospital Caucasian Aboriginal Asian Other
Total 

births

Total number 
of women who 

gave birth

Metropolitan teaching

Women s &amp; Children s Hospital (W&amp;CH) 2,879 213 1,273 526 4,891 4,740

Flinders Medical Centre (FMC) 2,748 98 319 219 3,384 3,322

Lyell McEwin Hospital (LMH) 2,457 148 423 305 3,333 3,298

Royal Adelaide Hospital (RAH) 1 0 0 0 1 1

Total 8,085 459 2,015 1,050 11,609 11,361

Metropolitan private

Ashford 1,300 4 122 28 1,454 1,422

Burnside War Memorial (BWMH) 1,071 0 79 15 1,165 1,145

Calvary 708 5 56 11 780 770

Flinders Private 506 1 18 10 535 528

North Eastern Community (NECH) 639 0 30 19 688 678

Total 4,224 10 305 83 4,622 4,543

Country

Level 4:4* Country 

Mt. Gambier 502 15 18 17 552 549

Pt Augusta 205 87 4 12 308 303

Subtotal 707 102 22 29 860 852

Level 3:3* Country ?100 births

Barossa Health (Tanunda Centre) 111 1 4 2 118 118

Gawler Health Service  542 15 10 3 570 570

Loxton District 101 5 1 0 107 107

Mt. Barker 354 5 9 5 373 373

Murray Bridge Soldiers  Memorial 196 21 13 7 237 237

Naracoorte 157 2 5 9 173 172

Northern Yorke Peninsula Regional 
Health Service (Wallaroo)

137 10 2 0 149 149

Pt. Lincoln 264 18 7 4 293 293

Pt. Pirie 122 14 2 5 143 143

Riverland Regional (Berri) 139 10 12 7 168 167

Whyalla 209 29 9 17 264 263

Subtotal 2,332 130 74 59 2,595 2,592

* Perinatal Service Delineation   see text for further explanation.

  This is a metropolitan hospital situated at the metropolitan/country boundary; it has the characteristics of a country hospital and has been included as such.

Pregnancy Outcome in South Australia 2013 page  19

Mothers and Babies



Table 3b continued

Hospital Caucasian Aboriginal Asian Other
Total 

births
Total women 

who gave birth 

Level 3:3* Country &lt;100 births

1-99 births per annum

Ceduna 30 12 0 2 44 44

Kangaroo Island 31 2 1 2 36 36

Kapunda 46 0 0 0 46 46

Lower North Health Centre (Clare) 78 1 2 1 82 82

Mid North Health (Jamestown) 42 2 0 0 44 44

Millicent 15 2 0 1 18 18

South Coast District  (Victor Harbor) 91 1 0 2 94 94

Southern Flinders Health Service 
(Crystal Brook)

34 1 0 0 35 35

Waikerie 47 2 1 4 54 54

Subtotal 414 23 4 12 453 453

Other Country

Cowell District 1 0 0 0 1 1

Marla 0 1 0 0 1 1

Pinnaroo Soldiers Memorial 0 0 0 1 1 1

Pitjantjatjara Homelands 0 1 0 0 1 1

Quorn 3 0 0 0 3 3

Southern Yorke Peninsula (Yorketown) 1 0 0 0 1 1

Streaky Bay Public 1 1 0 0 2 2

Subtotal 6 3 0 1 10 10

Total (country) 3,459 258 100 101 3,918 3,907

Grand total 15,768 727 2,420 1,234 20,149 19,811

* Perinatal Service Delineation   see text for further explanation

3. Maternal and baby race
The distribution of women who gave birth, by race is provided in Table 4a and also by category of birthplace in Table 
4b. In these tables and all others where distribution by race is shown,  Aboriginal  includes Aboriginal (685 women), 
Torres Strait Islander (14 women) and those who are Aboriginal and Torres Strait Islander (18 women). Aboriginal 
women accounted for 3.6% of women and gave birth mainly in metropolitan teaching hospitals and country 
hospitals. Asian women accounted for 12% of women, and gave birth mainly in metropolitan teaching hospitals, but 
12.7% gave birth in private hospitals.

For the first time in 2012, the Indigenous status of the baby was also collected independently of the mother. In 2013 
there were 952 Indigenous babies, representing 4.8% of all babies born. They comprised 904 (95%) Aboriginal, 17 
(1.8%) Torres Strait Islander and 31 (3.3%) Aboriginal and Torres Strait Islander.

Pregnancy Outcome in South Australia 2013page 20

Mothers and Babies



Table 4a: Race of women who gave birth, South Australia, 2013

Race Number of women % Women

Caucasian 15,600 78.3

Aboriginal 717 3.6

Asian 2,394 12.0

Other 1,214 6.1

Total 19,925 100.0

Table 4b: Table 4b: Race and birthplace category of women who gave birth, South Australia, 2013

Birthplace

Race of women

TotalCaucasian Aboriginal Asian Other

Number % Number % Number % Number % Number %

Metropolitan 
teaching hospital

7,895 50.6 449 62.6 1,988 83.0 1,029 84.8 11,361 57.0

Metropolitan  
private hospital

4,147 26.6 9 1.3 304 12.7 83 6.8 4,543 22.8

Country hospital 3,449 22.1 257 35.8 100 4.2 101 8.3 3,907 19.6

Home 109 0.7 2 0.3 2 0.1 1 0.1 114 0.6

Total 15,600 (78.3) 717 (3.6) 2,394 (12.0) 1,214 (6.1) 19,925 100.0

4. Maternal age
Among the five-year age groups, the largest number of women who gave birth was in the 30-34 years age group 
(Table 4c). The proportion of women in this age group (33%) has exceeded that of the 25-29 years age group 
(29.4%) since 2001. Teenage women accounted for 3.3% of women who gave birth and older women aged 35 years 
or more accounted for 19.8% (Table 4c and Figure 3). Aboriginal women were generally younger than non-Aboriginal 
women: 13.5% were teenagers and only 7.8% were 35 years or older. Among Asian women, on the other hand, only 
0.7% were teenagers but 19.4% were 35 years or older. 

The age-specific fertility rates have remained steady in the 20-24, 30-34,35-39 and 40+ age groups  and decreased 
in the 15-19 and 25-29 groups, when compared with 2012 (Table 4d). The rate was highest in the age group 30-34 
years (124.7 per 1,000 women), followed by the 25-29 years age group (104.5 per 1,000 women). The general 
fertility rate (see Appendix 1) was 61.7 per 1,000 women aged 15-44 years, down from 63.1 in 2012. The total 
fertility rate (see Appendix 1) was 1.85 live births per woman, lower than 2012 which at 1.91 was the same as 2008 
the highest for more than a decade, but still below replacement level (2.1).

Pregnancy Outcome in South Australia 2013 page  21

Mothers and Babies



Table 4c: Age and race of women who gave birth, South Australia, 2013

Age  
(years)

Caucasian Aboriginal Asian Other Total

Number % Number % Number % Number % Number %

&lt;15 3 0.0 5 0.7 0 0.0 2 0.2 10 0.0

15-19 515 3.3 92 12.8 17 0.7 32 2.6 656 3.3

20-24 2,232 14.3 263 36.7 176 7.4 210 17.3 2,881 14.5

25-29 4,478 28.7 213 29.7 793 33.1 374 30.8 5,858 29.4

30-34 5,152 33.0 88 12.3 945 39.5 391 32.2 6,576 33.0

35-39 2,546 16.3 46 6.4 390 16.3 176 14.5 3,158 15.9

40-44 648 4.2 10 1.4 71 3.0 28 2.3 757 3.8

45+ 26 0.2 0 0.0 2 0.1 1 0.1 29 0.1

Total 15,600 (78.3) 717 (3.6) 2,394 (12.0) 1,214 (6.1) 19,925 100.0

Figure 3: Age and race of women who gave birth, 2013 (n=19,925)

0%

20%

40%

60%

80%

100%

Caucasian 
n=15,600

Aboriginal
n=717

Asian
n=2,394

Other
n=1,214

Total
n=19,925

Pe
rc

en
ta

g
e 

o
f 

w
o

m
en

14-19 20-24 25-29 30-34 35+ Age (years)

Pregnancy Outcome in South Australia 2013page 22

Mothers and Babies



Table 4d: Age  specific fertility rates (ASFR), South Australia, 2013

Age 
(years) Number of live births

Estimated resident  
female population*

Age-specific fertility rate per  
1,000 women (ASFR) 

&lt;15 10 na na

15-19 656 50,918 13.1

20-24 2,897 55,868 51.9

25-29 5,900 56,460 104.5

30-34 6,650 53,325 124.7

35-39 3,204 51,246 62.5

40-44 772 58,198 13.8

45+ 31 na na 

Total 20,110 326,015 61.7

*   Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2013. Canberra: ABS, 2013 (Catalogue No 3235.0).

#   the number of live births and fertility rate for women aged 15-19 years include live births for younger ages, and the number and rate for women 
aged 40-44 years include live births for older ages, while the total number and  rate (general fertility rate) include all live births. Live births in this table 
exclude terminations of pregnancy. 

    Sum of 5-year ASFRs = 370.5 per 1,000 women. Total fertility rate = 369.7 x 5 = 1,852.3 live births per 1,000 women = 1.85 live births per woman.

5. Country of birth
The distribution of women by country of birth is provided in Table 5a by major group, and in Table 5b by specified 
countries of birth that had 40 or more women who gave birth. Of the 24.4% of women born outside Australia, the 
largest proportion was born in India (4% of women). Other countries contributing relatively large proportions of 
migrant women were the United Kingdom and Ireland (2.5%), China (2.2%), Vietnam (1.2%) the Philippines (1%), 
New Zealand (0.9%), Sudan, (0.7%), Afghanistan (0.6%),  Malaysia (0.6%), Pakistan (0.5%), Bangladesh, Cambodia, 
Iran, Sri Lanka, South Africa, Thailand and the United States of America (0.4% each), Congo, Indonesia, Iraq, Japan, 
Nepal and Poland, (0.3% each), and Burundi, Canada, Germany and Myanmar (Burma) (0.2% each).

Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2013

Country of birth Number %

1 Oceania and Antarctica 15,280 76.7

2 Europe and the USSR 933 4.7

3 The Middle East and North Africa 392 2.0

4 Southeast Asia 841 4.2

5 Northeast Asia 619 3.1

6 Southern Asia 1,247 6.3

7 Northern America 118 0.6

8 South America, Central America and the Caribbean 116 0.6

9 Africa (excluding North Africa) 378 1.9

Unknown 1 0.0

Total 19,925 100.0

* Australian Bureau of Statistics. Australian Standard Classification of Countries for Social Statistics (ASCCSS).  Canberra: ABS, 1990 (Catalogue No 
1269.0).

Pregnancy Outcome in South Australia 2013 page  23

Mothers and Babies



Table 5b: Specified country of birth,* women who gave birth, South Australia, 2013

Specified country of birth Number % of women % of migrant women who gave birth (n=4,864)

1100 Australia 15,061 75.6

6104 India 790 4.0 16.2

2101 UK/Ireland 491 2.5 10.1

5101 China 432 2.2 8.9

4110 Vietnam 231 1.2 4.7

4107 Philippines 201 1.0 4.1

1301 New Zealand 178 0.9 3.7

3207 Sudan 134 0.7 2.8

6101 Afghanistan 125 0.6 2.6

4105 Malaysia 110 0.6 2.3

6107 Pakistan 102 0.5 2.1

6108 Sri Lanka 87 0.4 1.8

4109 Thailand 83 0.4 1.7

3103 Iran 81 0.4 1.7

9220 South Africa 76 0.4 1.6

4102 Cambodia 73 0.4 1.5

6102 Bangladesh 72 0.4 1.5

7104 USA 72 0.4 1.5

5105 South Korea 71 0.4 1.5

2504 Poland 60 0.3 1.2

4103 Indonesia 58 0.3 1.2

5103 Japan 57 0.3 1.2

6106 Nepal 56 0.3 1.2

9106 Congo 56 0.3 1.2

3104 Iraq 55 0.3 1.1

4106 Myanmar (Burma) 47 0.2 1.0

2305 Germany 46 0.2 0.9

9203 Burundi 45 0.2 0.9

7102 Canada 43 0.2 0.9

All other countries 931 4.7 19.1

Unknown 1 0.0 0.0

Total 19,925 100.0 100.0

* ASCCSS, Australian Bureau of Statistics

Pregnancy Outcome in South Australia 2013page 24

Mothers and Babies



6. Marital status and type of patient
While 89.9% women who gave birth in 2013 were married or in a de facto relationship, 10.1% were single (8.8% 
were never married and 1.3% were widowed, separated or divorced, Table 6a). Of never married women, a fifth were 
teenagers and a third were in their early twenties. Relatively more single women were hospital/public patients than 
married women and women in de facto relationships (93.3% v 70.4%, Table 6b). Just over 27% of all women were 
private patients.

Table 6a: Marital status and age, women who gave birth, South Australia, 2013

Age 
(years)

Marital status of women

TotalNever married Married/de facto
Widowed/ 

separated /divorced Unknown

Number % Number % Number % Number % Number %

&lt;20 349 19.9 315 1.8 0 0.0 2 14.3 666 3.3

20-24 579 33.0 2,248 12.6 49 19.5 5 35.7 2,881 14.5

25-29 404 23.0 5,385 30.1 66 26.3 3 21.4 5,858 29.4

30-34 246 14.0 6,272 35.0 57 22.7 1 7.1 6,576 33.0

35-39 135 7.7 2,966 16.6 54 21.5 3 21.4 3,158 15.8

40-44 39 2.2 694 3.9 24 9.6 0 0.0 757 3.8

45+ 1 0.1 27 0.2 1 0.4 0 0.0 29 0.1

Total 1,753 (8.8) 17,907 (89.9) 251 (1.3) 14 (0.1) 19,925 100.0

Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2013

Type of  
patient

Marital status of women

TotalNever married Married/ de facto
Widowed/ 

separated/ divorced Unknown

Number % Number % Number % Number % Number %

Hospital/
public

1,636 93.3 12,600 70.4 238 94.8 13 92.9 14,487 72.7

Private 117 6.7 5,307 29.6 13 5.2 1 7.1 5,438 27.3

Total 1,753 (8.8) 17,907 (89.9) 251 (1.3) 14 (0.1) 19,925 100.0

Pregnancy Outcome in South Australia 2013 page  25

Mothers and Babies



7. Occupation of father and mother
This categorisation is based on the Australian Statistical Classification of Occupations (ASCO) of the Australian Bureau 
of Statistics and is provided in Table 7. Unclassified occupations have been assigned a separate category (Category 9). 

A much larger proportion of mothers than fathers (24.3 versus 0.4%) were included in the occupation  home duties . 
Larger proportions were also found for the groups of clerks and salespeople and personal service workers. More 
fathers were managers and administrators, tradespeople, plant and machine operators and labourers. Occupation was 
unknown for 9.4% of fathers and 3.7% of mothers.

Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2013

Occupation

Father Mother

Number % Number %

1 Managers and administrators 2,808 14.1 1,480 7.4

2 Professionals 3,158 15.8 3,384 17.0

3 Para professionals 1,079 5.4 1,406 7.1

4 Tradespersons 3,590 18.0 625 3.1

5 Clerks 513 2.6 2,110 10.6

6 Salespersons and personal service workers 1,064 5.3 2,764 13.9

7 Plant and machine operators and drivers 1,266 6.4 63 0.3

8 Labourers and related workers 2,515 12.6 526 2.6

9 Students 580 2.9 920 4.6

Pensioners 82 0.4 45 0.2

Home duties 78 0.4 4,832 24.3

Unemployed 987 5.0 809 4.1

Other 329 1.7 223 1.1

Unknown 1,876 9.4 738 3.7

Total 19,925 100.0 19,925 100.0

*  Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. (Catalogue No. 1223.0).

Pregnancy Outcome in South Australia 2013page 26

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8. Previous pregnancy outcomes
Forty-three percent of women had no previous birth and 31.4% were pregnant for the first time. Among Aboriginal 
women and those of  other  races, these proportions were lower, with 35.8% and 37.6% respectively giving birth for 
the first time. The proportion of women giving birth for the first time was the highest among Asian women (51.6%). 

The proportion of women of parity 4 or greater was much higher among Aboriginal women (10%) and women of 
 other  races (9.6%), than among Caucasian women (2.7%) and Asian women (1.3%) (Table 8a).

Table 8a: Parity by race, women who gave birth, South Australia, 2013

Parity

Race of women

TotalCaucasian Aboriginal Asian Other

Number % Number % Number % Number % Number %

0-primigravida 4,809 30.8 196 27.3 900 37.6 343 28.3 6,248 31.4

0-multigravida 1,876 12.0 61 8.5 335 14.0 114 9.4 2,386 12.0

1 5,449 34.9 172 24.0 881 36.8 361 29.7 6,863 34.4

2 2,341 15.0 142 19.8 192 8.0 179 14.7 2,854 14.3

3 706 4.5 74 10.3 56 2.3 100 8.2 936 4.7

4 244 1.6 33 4.6 21 0.9 61 5.0 359 1.8

?5 175 1.1 39 5.4 9 0.4 56 4.6 279 1.4

Total 15,600 78.3 717 3.6 2,394 12.0 1,214 6.1 19,925 100.0

Among women with previous pregnancies (multigravid women), the proportions who had had previous specified 
adverse pregnancy outcomes are shown in Table 8b. Just over a third of the women had a previous miscarriage and a 
fifth a termination of pregnancy.

Table 8b: Previous pregnancy outcomes, women who gave birth, South Australia, 2013  
(multigravidae only, n= 13,677)

Previous pregnancy outcome Number %

Miscarriage 4,819 35.2

Termination of pregnancy 2,780 20.3

Stillbirth 189 1.4

Neonatal death 86 0.6

Ectopic pregnancy 331 2.4

Of the 11,291 women who had previously given birth, 3,467 (30.7%) had a previous caesarean section.

Pregnancy Outcome in South Australia 2013 page  27

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9a. Gestation at first antenatal visit
In 2013 gestation at the first antenatal visit was reported as  unknown  for 5.3% of women (Table 9a). If these 
women with an unknown number of visits are excluded, among the remaining women, 80.8% attended within 
the first 14 weeks. This proportion was much lower for Aboriginal women (53.4%) than for non-Aboriginal women 
(81.7%).

Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2013 (n=19,925)

Gestation 
at first 
antenatal 
visit

Race of women

TotalNon-Aboriginal Aboriginal

Number %

Adjusted % 
(excluding 

 unknown ) 
(n=18,213)

Number %

Adjusted % 
(excluding 

 unknown ) 
(n=657)

Number %

Adjusted % 
(excluding 

 unknown ) 
(n=18,870)

&lt;14 weeks 
gestation

14,889 77.5 81.7 351 49.0 53.4 15,240 76.5 80.8

14 weeks or 
greater*

3,324 17.3 18.3 306 42.7 46.6 3,630 18.2 19.2

Unknown 995 5.2 60 8.4 1,055 5.3

Total 19,208 96.4 100.0 717 3.6 100.0 19,925 100.0 100.0

*includes 33 women with no antenatal care

9b. Body Mass Index (BMI)
Reported height and weight at the first antenatal visit were used to calculate the Body Mass Index (BMI, see Appendix 
1) for women who gave birth. This was considered valid only for women who attended the first antenatal visit before 
20 weeks gestation. Among these 17,911 women (89.9% of all women who gave birth), height and weight were not 
reported for 1,689 women (9.4%), so that BMI could only be calculated for 16,222 women who gave birth in 2013 
(81%). Table 9b shows that 8,423 women recorded a BMI &gt;=25.0 (42.3% of all women giving birth), 3,900 (19.5%) 
had a BMI &gt;=30.0, and 1,641 (8.2%) had a BMI &gt;=35.0.

Table 9b: BMI of women who gave birth, South Australia, 2013

BMI 

(based on height and weight  
at first antenatal visit where gestation 
at first  antenatal visit was &lt;20 weeks)

Number %
Adjusted %  

(excluding  unknown ) 
(n=16,222)

&lt;18.5 (underweight) 426 2.4 2.6

18.5   24.9 (normal) 7,373 41.2 45.5

25.0   29.9 (overweight) 4,523 25.3 27.9

30.0   34.9 (obese) 2,259 12.6 13.9

35.0   39.9 (severely obese) 1,004 5.6 6.2

40 or more (morbidly obese) 637 3.6 3.9

Unknown 1,689 9.4

Total 17,911 100.0

Pregnancy Outcome in South Australia 2013page 28

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9c. Antenatal visits
Women who gave birth are grouped in Table 9c according to the number of reported antenatal visits: no visits, 1 - 6 
visits, 7 or more visits. However, for 4.7% of women (9.8% of Aboriginal women), the number of antenatal visits 
attended was not reported. If women for whom the number of antenatal visits was not reported are excluded, 26.1% 
of Aboriginal women compared with 7.3% of Caucasian women were reported to have made fewer than 7 visits. 
Among Asian women this proportion was 10.2%. A low frequency of antenatal visits may be taken, particularly in 
term births, as an indication of inadequate antenatal care. Although the exact number of antenatal visits was reported 
for 18,982 (95.3%) women, 19,892 (99.8%) women report having attended at least one antenatal visit.

Table 9c: Antenatal visits by race, women who gave birth, South Australia, 2013

Antenatal  
visits

Race of women

TotalCaucasian Aboriginal Asian Other

Number % Number % Number % Number % Number %

None 22 0.1 9 1.3 1 0.0 1 0.1 33 0.2

1-6 1,061 6.8 160 22.3 232 9.7 168 13.8 1,621 8.1

?7 13,806 88.5 478 66.7 2,055 85.8 989 81.5 17,328 87.0

Unknown 
number of 
visits 

711 4.6 70 9.8 106 4.4 56 4.6 943 4.7

Total 15,600 (78.3) 717 (3.6) 2,394 (12.0) 1,214 (6.1) 19,925 (100.0)

9d. Type of antenatal care
In 2012 the types of antenatal care collected were updated to better reflect current obstetric practice. Table 9d 
shows that the main types of antenatal care used were public hospital clinic (Specialist led) (41.5%), Obstetricians  
+/-midwife in private practice (26.8%), General Practitioners and public hospital (shared care) (13.7%), Midwifery 
group practice at birth hospital (11.1%) and General Practice led (8.6%). Individual women may have used more than 
one type of antenatal care. There were 33 women (0.2%) who had no antenatal care.

Table 9d: Type of antenatal care, women who gave birth, South Australia, 2013 (n = 19,925)

Type of care Number %

No care 33 0.2

Midwifery group practice at birth hospital 2,212 11.1

Birth Unit/Centre 1,306 6.6

Public clinic (Specialist led) 8,263 41.5

GP and public hospital (shared care) 2,734 13.7

GP led 1,710 8.6

Obstetrician +/- midwife in private practice 5,341 26.8

Eligible midwife in private practice 68 0.3

Aboriginal Family Birthing Program (includes metropolitan and rural 
locations)

181 0.9

Other 34 0.2

Not stated 16 0.1

Pregnancy Outcome in South Australia 2013 page  29

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10. Smoking
Table 10a shows that 11.1% of all women were reported to be smokers at their first antenatal visit, and 3.3% had 
quit smoking before their first visit.  Smoking status was unknown for 1.1% of women. The proportion of all women 
smoking during pregnancy has been declining in the state, from 25% in 1998 to 11.1% in 2013. 

The proportion of Aboriginal women who reported that they smoked at the first antenatal visit was (45%) down 
slightly from 2012 (49.4%). However, this was considerably higher than non-Aboriginal women (9.8%). Additionally, 
5.2% of Aboriginal women reported that they quit smoking in pregnancy prior to their first antenatal visit, compared 
with 3.2% of non-Aboriginal women. 

The highest rates of smoking were among teenagers (29%) and women aged 20-24 years (20.7%). Smoking rates 
were high among all age groups of Aboriginal women varying from 34% among teenage women to 44.9% among 
those aged 20-24 years. 

In the second half of pregnancy (Table 10b), 9.6% of women (1,911 women) were reported to be smokers and 0.3% 
(62 women) smoked more than 20 cigarettes per day, but the number of cigarettes smoked or whether the woman 
smoked in the second half of pregnancy was not known for 1.7% of women. In the second half of pregnancy, 41.1% 
of Aboriginal women smoked, compared with 8.3% of non-Aboriginal women. A higher proportion of Aboriginal 
women (1.1% compared with 0.3%) also smoked more than 20 cigarettes per day, but the number of cigarettes 
smoked was not known for 5.9% of Aboriginal women and 1.5% of non-Aboriginal women.

Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women who gave 
birth, South Australia, 2013

Smoking status

Non-Aboriginal Aboriginal Total

Number % Number % Number %

Smoker 1,883 9.8 323 45.0 2,206 11.1

Quit before 1st visit 614 3.2 37 5.2 651 3.3

Non-smoker 16,505 85.9 339 47.3 16,844 84.5

Unknown smoking status 206 1.1 18 2.5 224 1.1

Total 19,208 96.4 717 3.6 19,925 100.0

Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy, non-
Aboriginal and Aboriginal women who gave birth, South Australia, 2013

Average number of tobacco 
cigarettes smoked per day

Non-Aboriginal Aboriginal Total

Number % Number % Number %

None 17,295 90.0 380 53.0 17,675 88.7

Occasional (&lt;1) 31 0.2 8 1.1 39 0.2

1-10 1,162 6.0 221 30.8 1,383 6.9

11-20 369 1.9 58 8.1 427 2.1

21-30 45 0.2 8 1.1 53 0.3

31-40 7 0.0 0 0.0 7 0.0

41+ 2 0.0 0 0.0 2 0.0

Unknown 297 1.5 42 5.9 339 1.7

Total 19,208 96.4 717 3.6 19,925 100.0

Pregnancy Outcome in South Australia 2013page 30

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11. Medical conditions
Medical conditions were recorded in the current pregnancy for 7,923 women (39.8%). The frequencies of specified 
medical conditions are provided in Table 11. Up to four conditions can be reported for each pregnancy.

Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2013

Medical condition Number % of women (n = 19,925)

1 None 12,002 60.2

2 Anaemia 1,389 7.0

3 Urinary tract infection 442 2.2

4 Hypertension (pre-existing) 234 1.2

5 Diabetes (pre-existing) 165 0.8

6 Epilepsy 102 0.5

7 Asthma 1,360 6.8

8 Other 5,928 29.8

12. Obstetric complications
Obstetric complications were recorded for 7,855 women who gave birth (39.4%). The reported frequencies of the 
more common complications are presented in Table 12. Up to four complications can be reported for each pregnancy.

There were three maternal deaths notified to the Maternal, Perinatal and Infant Mortality Committee in 2013,  one 
direct maternal death, one indirect maternal death and one incidental maternal death (see definition in Appendix 1).

Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2013

Obstetric complication Number % of women  (n= 19,925)

No complication 12,070 60.6

Threatened miscarriage 259 1.3

Antepartum haemorrhage (APH) - Abruption 80 0.4

APH - Placenta praevia 113 0.6

APH   Other &amp; unknown causes 454 2.3

Pregnancy hypertension 1,476 7.4

Intrauterine growth restriction (suspected) 930 4.7

Gestational diabetes 1,636 8.2

Other complications (including 7 women with impaired 
glucose tolerance) 4,626 23.2

Pregnancy Outcome in South Australia 2013 page  31

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13. Procedures performed in current pregnancy
In 2012 procedures performed in the current pregnancy that are collected on the Supplementary Birth Record 
were updated to better reflect current obstetric practice, and are presented in Table 13. At least one ultrasound 
examination was performed for 97.6% of women, amniocentesis for 3.4% and chorion villus sampling for 0.8%.

For a proportion of women, it was not known whether a specific procedure had been performed, eg 1.4% for a first 
trimester screen and 1.5% for a second trimester screen.  It is hoped that the increasing use of the Pregnancy Record 
will continue to reduce the number of  unknown  entries.

Table 13: Procedures performed in current pregnancy, women who gave birth, South Australia, 2013

Procedure
Yes No Unknown

Number % Number % Number %

First trimester anomaly screen  
(Ultrasound &amp; biochem) 13,498 67.7 6,144 30.8 283 1.4

Second trimester anomaly screen  
(biochem only) 3,160 15.9 16,467 82.6 298 1.5

Ultrasound dating scan 11,263 56.5 7,436 37.3 1,226 6.2

Ultrasound morphology scan 17,331 87.0 2,400 12.0 194 1.0

Other ultrasound scan 7,700 38.6 11,938 59.9 287 1.4

Amniocentesis 679 3.4 19,093 95.8 153 0.8

Chorion villus biopsy 162 0.8 19,610 98.4 153 0.8

Antenatal fetal blood sampling 12 0.1 19,765 99.2 148 0.7

Other surgical procedure 98 0.5 19,827 99.5 0 0.0

14a. Onset of labour
Labour occurred spontaneously in 49.0% of women who gave birth (Table 14a).  It was induced in 32.5%, and the 
methods of induction used were artificial rupture of membranes (ARM) in 68.7% of inductions, prostaglandins in 
54.1% and oxytocics in 57.5% (Table 14b).  In many cases more than one method was used.

Table 14a:  Onset of labour, women who gave birth, South Australia, 2013

Onset of labour Number %

Spontaneous 9,773 49.0

No labour   caesarean section 3,676 18.4

Induction 6,476 32.5

Total 19,925 100.0

Table 14b: Method of induction of labour, women who gave birth, South Australia, 2013

Method of induction Number % of women (n =19,925) % of inductions (n =6,476)

No induction 13,449 67.5

ARM 4,450 22.3 68.7

Oxytocics 3,725 18.7 57.5

Prostaglandins 3,501 17.6 54.1

Pregnancy Outcome in South Australia 2013page 32

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14b. Reasons for induction of labour
Up to two reasons could be provided for induction. These reasons for induction of labour are defined (see page 55) in 
 The Australian Council on Healthcare Standards Obstetrics Indicators - Clinical Indicator Users  Manual Version 5 for 
use in 2007 .

Figure 4 demonstrates that 16.6% of women were induced for prolonged pregnancy (41 or more completed weeks),  
15% for hypertension, 9.5% for diabetes (including gestational diabetes and glucose intolerance), 7.8% for 
intrauterine growth restriction (IUGR) and 9.5% for premature rupture of membranes (PROM). Other defined reasons 
accounted for smaller proportions. Other than defined reasons accounted for 45.7%.

Figure 4: Reasons for induction of labour, SA, 2013 (n=6,476)

The proportion of women giving birth who had labour augmented was 17.7%. Of the 9,773 women who went 
into spontaneous labour, augmentation was used for 3,530 (36.1%). Methods used in augmentation were artificial 
rupture of membranes (ARM) (72.3%), oxytocics (43.4%) and prostaglandins (0.9%). More than one method may be 
used. It should be noted that prostaglandins are not recommended by the manufacturers as a method of augmenting 
labour.

Table 14c:  Augmentation of labour after spontaneous onset, women who gave birth, South Australia, 2013

Method of augmentation Number % of women (n=19,925) % of augmentations (n=3,530)

Any augmentation 3,530 17.7

1 ARM 2,552 12.8 72.3

2 Oxytocics 1,532 7.7 43.4

3 Prostaglandins 33 0.2 0.9

0 10 20 30 40 50 60

Other

Prolonged pregnancy

Chorioamnionitis

Fetal death

Fetal distress

Isoimmunisation

IUGR

Hypertensive disorders

PROM

Diabetes*

Percentage

*includes diabetes mellitus, gestational diabetes and glucose intolerance

Pregnancy Outcome in South Australia 2013 page  33

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15a. Presentation and method of birth
Of the women who gave birth, 53.9% had normal spontaneous vaginal births (Table 15a and Figure 5a). Caesarean 
section was performed for 34% of women, with 16.2% of women having elective sections; forceps were utilised for 
5.6%, ventouse for 5.9% and breech birth for the remaining 0.5%. The method of birth given for women who had 
multiple births is that for the first birth. The method of birth by presentation for all births is provided in Table 15b. 
Breech presentation occurred in 4.8% of births and caesarean section was the method of birth for 87.7% of breech 
presentations. Caesarean section was also utilised for 87.7% of breech presentations in singletons (Table 15c).

Table 15a: Method of birth, women who gave birth, South Australia, 2013

Method of birth Number %

Normal spontaneous vaginal 10,746 53.9

Forceps 1,124 5.6

Assisted breech (no forceps) 22 0.1

Caesarean section (elective) 3,237 16.2

Caesarean section (emergency) 3,541 17.8

Ventouse 1,175 5.9

Breech extraction 5 0.0

Breech spontaneous 71 0.4

Assisted breech (with forceps for head) 3 0.0

Unknown 1 0.0

Total 19,925 100.0

Figure 5a: Method of birth, women who gave birth, South Australia, 2013 (n = 19,925)

Ventouse (5.9%)

Caesarean section (34%)
Normal
spontaneous
vaginal (53.9%)

 
 

Breech delivery (0.5%)
Forceps (5.6%)

Pregnancy Outcome in South Australia 2013page 34

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Table 15b: Method of birth by presentation, all births, South Australian 2013 (n=20,263)

Method of 
birth

Presentation

TotalVertex Breech Other Unknown

Number % Number % Number % Number % Number %

Normal 
spontaneous 10,732 56.4 0 0.0 55 23.7 7 26.9 10,794 53.3

Forceps 1,127 5.9 0 0.0 9 3.9 0 0.0 1,136 5.6

Assisted breech 
(no forceps) 0 0.0 27 2.8 0 0.0 0 0.0 27 0.1

Elective 
caesarean 2,798 14.7 516 52.7 40 17.2 5 19.2 3,359 16.6

Emergency 
caesarean 3,194 16.8 343 35.0 122 52.6 12 46.2 3,671 18.1

Ventouse 1,175 6.2 0 0.0 5 2.2 0 0.0 1,180 5.8

Breech  
extraction 0 0.0 12 1.2 0 0.0 0 0.0 12 0.1

Breech 
spontaneous 0 0.0 76 7.8 1 0.4 1 3.8 78 0.4

Assisted breech  
(forceps) 0 0.0 5 0.5 0 0.0 0 0.0 5 0.0

Unknown 0 0.0 0 0.0 0 0.0 1 3.8 1 0.0

Total 19,026 (93.9) 979 (4.8) 232 (1.1) 26 (0.1) 20,263 100.0

Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia, 2013 (n = 979)

Plurality Assisted* breech
Elective 

caesarean
Emergency 
caesarean

Breech 
extraction

Breech 
spontaneous Total

Singleton 25 424 269 5 67 790

Twins 7 88 70 7 8 180

Triplets 0 4 4 0 1 9

Total 32 516 343 12 76 979

* in five of the assisted breech births forceps were applied to the head.

Pregnancy Outcome in South Australia 2013 page  35

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15b. Reason for caesarean section
Up to two reasons may be provided on the Supplementary Birth Record for caesarean section, and these have been 
collated in Figure 5b (all caesarean sections), Figure 5c (elective caesarean sections only) and Figure 5d (emergency 
caesarean sections only). The main reasons given for all caesarean sections were previous caesarean section (36.1%), 
failure to progress/cephalopelvic disproportion (CPD) (27.1%), fetal distress (14.8%) and malpresentation (11%).
Maternal choice accounted for 2.6% (up from 1.5%in 2012 when it was first added). The main reasons for elective 
sections were previous caesarean section (65.3%), malpresentation (13.1%), maternal choice (4.4%) and multiple 
pregnancy (3.2%). The main reasons given for emergency sections were failure to progress or CPD (50.5%), fetal 
distress (28.2%), previous caesarean section (9.4%), malpresentation (9.1%) and maternal choice (0.9%). 

Figure 5b: Reason for caesarean section, 2013 (n=6,778)

Figure 5c: Reason for elective caesarean section, 2013 (n=3,237)

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 

Other 

Maternal choice 

Intrauterine Growth
 Restriction (IUGR)

Multiple pregnancy 

Antepartum
 Haemorrhage (APH)

Pregnancy hypertension/
hypertension 

Malpresentation 

Fetal distress

Previous caesarean 

CPD/Failure to progress 

Percentage 

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 

Other 

Maternal choice 

IUGR 

Multiple pregnancy 

APH 

Pregnancy hypertension/
hypertension

Malpresentation 

Fetal distress 

Previous caesarean 

CPD 

Percentage 

Pregnancy Outcome in South Australia 2013page 36

Mothers and Babies



Figure 5d: Reason for emergency caesarean section, 2013 (n=3,541)

16. Complications of labour and birth and perineal status after birth
Complications of labour or birth were recorded for 7,552 women who gave birth (37.9%). Up to four complications 
can be recorded. The reported frequency of some complications is presented in Table 16. Among all 19,925 women 
who gave birth, episiotomy was performed for 2,653 (13.3%). Among the 13,147 women who gave birth vaginally, 
3,400 (25.9%) had an intact perineum after birth, 5,282 (40.2%) had a repair of a perineal tear, of whom 431 (3.3%) 
had a third or a fourth degree tear; 20.2% had an episiotomy. 

Table 16: Frequency of some complications of labour and birth, women who gave birth, South Australia, 2013

Complication of labour Number of women % of women (n=19,925)

None 12,373 62.1

Postpartum Haemorrhage (PPH) - 600-999ml 1,559 7.8

PPH   1,000 ml or more 909 4.6

PPH   primary (amount not specified) 7 0.0

Fetal distress 2,316 11.6

Retained placenta 255 1.3

Prolonged labour 140 0.7

Cord prolapse 35 0.2

Wound infection 16 0.1

Third degree tear (391) or fourth degree tear (31) 431 2.2

Failure to progress 2,558 12.8

Other 4,794 24.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0 

Other 

Maternal choice 

IUGR 

Multiple pregnancy 

APH 

Pregnancy hypertension/hypertension 

Malpresentation 

Fetal distress 

Previous caesarean 

CPD/Failure to progress 

Percentage 

Pregnancy Outcome in South Australia 2013 page  37

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17. Fetal monitoring during labour
Cardiotocography (CTG) was performed during labour for 63.3% of women who gave birth. The majority of these 
(49.9% of women) were external CTGs (Table 17a) while a scalp clip was used for 13.4%. 

A fetal scalp pH was taken during labour in 214 women who gave birth (1.1%, Table 17b).

Table 17a: CTG performed during labour, women who gave birth, South Australia, 2013

CTG during labour Number of women % of women (n=19,925)

1 None 7,310 36.7

2 External 9,936 49.9

3 Scalp clip 2,679 13.4

Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2013

Fetal scalp pH taken Number of women % of women (n=19,925)

1 No 19,711 98.9

2 Yes 214 1.1

18. Analgesia for labour and anaesthesia for birth
These distributions are provided in Tables 18a and 18b. Epidurals were used for analgesia in labour for 31.3% and 
for anaesthesia for birth for 27.3% of women. The proportion of women who had an epidural for either was 32.6% 
(6,501 women). The proportion of women who had a spinal anaesthetic increased between 1991 and 2013 from 
0.2% to 1.0% for analgesia and from 0.5% to 25.2% for anaesthesia. General anaesthesia was used for 2.1% of 
births. It was used in 5.9% of caesarean sections. Approximately 37% of women who gave birth received none of the 
specified methods for analgesia during labour.

Table 18a:  Analgesia for labour,* women who gave birth, South Australia, 2013

Analgesia Number % of women

1 None 7,339 36.8

2 Nitrous oxide and oxygen 8,245 41.4

3 Narcotic (parenteral) 3,157 15.8

4 Epidural (lumbar/caudal) 6,237 31.3

5 Spinal 192 1.0

6 Other 489 2.5

7 Combined spinal-epidural 14 0.1

 * more than one method may be used for each woman

Pregnancy Outcome in South Australia 2013page 38

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Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2013

Anaesthesia Number % of women

1 None 7,476 37.5

2 Local anaesthesia 1,762 8.8

3 Pudendal 159 0.8

4 Epidural (lumbar/caudal) 5,431 27.3

5 Spinal 5,015 25.2

6 General anaesthesia 409 2.1

7 Other 178 0.9

8 Combined spinal-epidural 68 0.3

* more than one method may be used for each woman

19. Postnatal length of stay of women
The distribution of length of stay of women who gave birth in hospitals is presented in Table 19a for public and 
private patients. The median duration for all women was three days. It was two days for vaginal births and four days 
for caesarean section births (Table 19b). 

The median duration of stay was two days longer for private patients for vaginal as well as caesarean births (four and 
five days respectively for private patients compared with two and three days respectively for public patients).

Table 19a: Postnatal length of stay by type of patient, women who gave birth in South Australian hospitals, 2013

Postnatal length of 
stay (days)

Public Private Total

Number % Number % Number %

&lt;1 924 6.4 26 0.5 950 4.8

  1 2,927 20.3 84 1.6 3,011 15.2

  2 3,764 26.1 215 4.0 3,979 20.1

  3 3,586 24.9 670 12.4 4,256 21.5

  4 1,931 13.4 2,151 39.9 4,082 20.6

  5 814 5.6 1,610 29.8 2,424 12.2

  6 238 1.7 470 8.7 708 3.6

  7 or more 233 1.6 168 3.1 401 2.0

Total 14,417 100.0 5,394 100.0 19,811 100.0

Table 19b: Average postnatal length of stay by type of patient &amp; type of birth, women who gave birth in 
South Australian hospitals, 2013

Average 
length of stay

Public Private Total

Vaginal  
(n=9,849)

Caesarean 
(n=4,568)

Total  
(n=14,417)

Vaginal  
(n=3,184)

Caesarean 
(n=2,210)

Total  
(n=5,394)

Vaginal  
(n=13,033)

Caesarean 
(n=6,778)

Total  
(n=19,811)

Mean number 
of days

2.0 3.7 2.5 3.8 5.0 4.3 2.4 4.1 3.0

 ( SD) ( 1.42) ( 1.58) ( 1.67) ( 1.42 ( 1.08) ( 1.43) ( 1.62) ( 1.57) ( 1.80)

Median 
number of days 2.0 3.0 2.0 4.0 5.0 4.0 2.0 4.0 3.0

Pregnancy Outcome in South Australia 2013 page  39

Mothers and Babies



20. Sex of baby
The sex distribution of babies is provided in Table 20; the male: female sex ratio was 1.08:1.

Table 20: Sex of baby, all births, South Australia, 2013

Sex of baby Number %

Male 10,531 52.0

Female 9,731 48.0

Indeterminate 1 0.0

Total 20,263 100.0

21. Birthweight and gestation
The birthweight distribution of all births is presented in Table 21. The percentage of low birthweight babies (&lt;2,500g) 
was 7.7%, and that of very low birthweight babies (&lt;1,500g) was 1.7%. The mean birthweight was 3,312g (SD 
624.8g), with birthweights ranging from 91g to 5850g. The proportion of low birthweight babies was 15.4% among 
babies of Aboriginal women compared with 7.4% among babies of non-Aboriginal women. Among live born babies, 
and excluding terminations of pregnancy, these proportions were 14.8% and 6.9% respectively.

Table 21:  Birthweight distribution of all births, South Australia, 2013

Birthweight (g) Number of births Percentage of births

&lt;400 50 0.2

400-499 21 0.1

500-749 62 0.3

750-999 67 0.3

1,000-1,499 137 0.7

1,500-1,999 339 1.7

2,000-2,499 876 4.3

2,500-2,999 3,314 16.4

3,000-3,499 7,386 36.5

3,500-3,999 5,922 29.2

4,000-4,499 1,801 8.9

4,500+ 287 1.4

Unknown 1 0.0

Total 20,263 100.0

In 2013, 1,552 babies (7.7%) were of low birthweight and 1,983 (9.8%) were preterm (&lt;37 weeks gestation). The 
proportion of preterm births was 18% among babies of Aboriginal women compared with 9.5% among babies of 
non-Aboriginal women. 

Pregnancy Outcome in South Australia 2013page 40

Mothers and Babies



22. Birth injuries
Birth injuries were reported in 168 live births (0.8%). The most common injury reported was cephalhaematoma. 
Fracture and nerve injury occurred less frequently (Table 22).

Table 22: Birth injuries* in 20,125 live births, South Australia, 2013

Birth injury Number of live births % of live births

None 19,957 99.2

Fracture 11 0.1

Dislocation 2 0.0

Nerve Injury 16 0.1

Cephalhaematoma 128 0.6

Other 14 0.1

*more than one injury may be reported for each birth

23. Treatment given in neonatal period
The proportions of live births who received specified treatments in the neonatal period are provided in Table 23, which 
shows that 83.9% of neonates did not receive any of these treatments.

Table 23: Neonatal treatment given, all live births, South Australia, 2013

Neonatal treatment Number % of live births

None of the treatments listed below 16,893 83.9

Oxygen therapy for more than 4 hours 860 4.3

Phototherapy for jaundice 1,391 6.9

Gavage feeding more than once 1,633 8.1

Any intravenous therapy 2,212 11.0

24. Level of care* utilised
Table 24 shows that 83.4% of neonates utilised Level 1-3 care only. Level 4 - 5 care was used by 16.5% of neonates, 
Level 6 care at the Women s and Children s Hospital or Flinders Medical Centre by 2.7% and paediatric intensive care 
at the Women s and Children s Hospital by 0.2% of neonates. As would be expected, with decreasing birthweight, an 
increasing percentage of babies required Level 4-5 and Level 6 care.

Table 24: Level of nursery care* utilised by birthweight, all live births, South Australia, 2013

Level of care utilised

Birthweight (g)

&lt;1,500 (n=238) 1,500-2,499 (n=1,204) 2,500+ (n=18,683) Total (n=20,125)

Number % Number % Number % Number %

Level I - 3 only 21 8.8 228 18.9 16,529 88.5 16,778 83.4

Level 4 - 5 208 87.4 972 80.7 2,137 11.4 3,317 16.5

Level 6 (W&amp;CH &amp; FMC) 192 80.7 191 15.9 159 0.9 542 2.7

Level 6 (W&amp;CH Paediatric 
intensive care) 5 2.1 5 0.4 40 0.2 50 0.2

*Standards for Maternal and Neonatal Services in South Australia 2010

Pregnancy Outcome in South Australia 2013 page  41

Mothers and Babies



25. Length of stay of babies
Table 25 shows the distribution of length of stay of liveborn babies in hospital for preterm (&lt;37 weeks gestation) and 
term births (?37 weeks gestation). The mean duration of stay for all liveborn babies was 4.8 days (SD 9.4) and the 
median duration 3 days. The mean duration was 3.2days (SD 3.2) for term births and 20.7 days (SD 23.8) for preterm 
births, while the median durations were 3 and 13 days respectively.

Table 25:  Length of stay of liveborn babies in hospital, South Australia, 2013

Length of stay (days)

Preterm births Term births Total

Number % Number % Number %

&lt;1 27 1.4 870 4.8 897 4.5

  1 24 1.3 2,813 15.5 2,837 14.2

  2 75 4.0 3,594 19.8 3,669 18.3

  3 100 5.4 3,806 21.0 3,906 19.5

  4 126 6.7 3,740 20.6 3,866 19.3

  5 138 7.4 2,189 12.1 2,327 11.6

  6 102 5.5 625 3.4 727 3.6

  7-13 377 20.2 383 2.1 760 3.8

  14-20 265 14.2 58 0.3 323 1.6

  21-27 184 9.9 27 0.1 211 1.1

  28 or more 449 24.0 39 0.2 488 2.4

Total 1,867 100.0 18,144 100.0 20,011 100.0

26. Congenital anomalies
Among the 20,263 births in 2013 there were 565 births (2.8%) notified with congenital anomalies, compared with an 
average of 2.5% over the past decade; 530 (2.6%) of these births had anomalies notified in the congenital anomalies 
range 74000-75999 of the British Paediatric Association (BPA) Classification of Diseases. This is a 5-digit extension of 
the 4-digit classification of the ICD-9 (International Classification of Diseases. Manual of the International Statistical 
Classification of Diseases, Injuries and Causes of Death, 1975 Revision. Geneva: World Health Organisation, 1977). 
Table 26 includes births with the more readily identifiable defects used for international monitoring (sentinel defects) 
notified to the perinatal statistics collection in 2003-2013.

Terminations of pregnancy are not included in this table unless they meet a criterion for inclusion in the perinatal data 
collection, i.e. at least 400g birthweight or 20 weeks gestation. Notifications of births with birth defects identified 
after discharge from the hospital of birth but within the first five years of life are made to the South Australian Birth 
Defects Register at the Women s and Children s Hospital, and more complete statistics on birth defects in South 
Australia are available from the Register s Annual Report.2

Pregnancy Outcome in South Australia 2013page 42

Mothers and Babies



Table 26: Selected congenital anomalies notified to the perinatal statistics collection, 2003-2013, South Australia

Congenital 
abnormality Year

BPA* CODE 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Number of births = 17,844 17,522 18,196 18,803 19,757 19,970 19,901 20,002 20,344 20,666 20,263

74000-74029 Anencephalus 0 1 0 1 1 1 3 1 2 2 2

74100-74199 Spina bifida 7 5 5 8 5 4 18 11 6 4 7

74200-74209 Encephalocele 0 0 1 1 2 1 0 1 0 1 2

74230-74239 Hydrocephalus 7 6 9 10 12 11 14 4 9 11 13

74900-74909 Cleft palate 9 10 15 11 12 9 11 12 11 14 12

74910-74929 Cleft lip and 
palate (Total cleft lip)

14 17 9 16 30 28 25 18 13 14 14

75030-75038 Tracheo-
oesophageal fistula, 
oesophageal atresia and 
stenosis

2 2 5 4 12 5 6 3 6 5 7

75120-75124 Atresia and 
stenosis of large intestine, 
rectum and anal canal

6 6 12 4 7 9 7 9 10 5 8

75260-75261 Hypospadias 
and epispadias

34 41 38 29 41 40 39 44 43 38 44

75300-75301 Renal agenesis 
and dysgenesis

10 4 12 8 8 3 11 8 12 10 7

75520-75549 Limb reduction 
defects

5 8 8 13 18 9 8 13 8 15 17

75660-75669 Anomalies of 
diaphragm

4 4 7 12 7 9 9 6 5 1 8

75670-75679 Anomalies of 
abdominal wall

13 12 9 10 7 9 17 7 15 14 8

75800-75809 Down 
syndrome

13 14 19 17 17 21 22 14 16 19 14

* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979.

27. Multiple births
Among women who gave birth there were 320 twin and 9 triplet pregnancies compared with 19,596 singleton 
ones in 2013. Thus there was one twin pregnancy in every 62 pregnancies, one triplet pregnancy in every 2,214 
pregnancies among women who gave birth. Women who gave birth with twins and triplets comprised 1.6% of all 
women who gave birth. The total number of multiple births was 667 (3.3% of total births).

A comparison of multiple births with singletons shows that multiple births were of lower birthweight (with 63% 
being of low birthweight compared with 5.8% for singletons, Table 27a), and gestation (with 70.6% being preterm 
births compared with 7.7% for singletons, Table 27b). The proportion of live births in hospital at 28 days was 26.1% 
for multiple births compared with 1.6% for singletons. The perinatal death rate for multiple births was 16.5 compared 
with 8.8 deaths per 1,000 births for singletons, Table 27c).

Pregnancy Outcome in South Australia 2013 page  43

Mothers and Babies



Table 27a: Birthweight by plurality, all births, South Australia, 2013

Birthweight (g)
Singleton births Multiple births

Number % Number %

&lt;400 46 0.2 4 0.6

400-499 21 0.1 0 0.0

500-749 52 0.3 10 1.5

750-999 45 0.2 22 3.3

1,000-1,499 98 0.5 39 5.8

1,500-1,999 202 1.0 137 20.5

2,000-2,499 668 3.4 208 31.2

2,500-2,999 3,114 15.9 200 30.0

3,000-3,499 7,344 37.5 42 6.3

3,500-3,999 5,917 30.2 5 0.7

4,000-4,499 1,801 9.2 0 0.0

4,500+ 287 1.5 0 0.0

Unknown 1 0.0 0 0.0

Total 19,596 100.0 667 100.0

Table 27b: Gestation at birth by plurality all births, South Australia, 2013

Gestation (weeks)
Singleton births Multiple births Total

Number % Number % Number %

&lt;24 94 0.5 7 1.0 101 0.5

24-27 68 0.3 28 4.2 96 0.5

28-31 131 0.7 54 8.1 185 0.9

32-36 1,219 6.2 382 57.3 1,601 7.9

37-41 18,027 92.0 196 29.4 18,223 89.9

42+ 56 0.3 0 0.0 56 0.3

Unknown 1 0.0 0 0.0 1 0.0

Total 19,596 100.0 667 100.0 20,263 100.0

Table 27c: Perinatal outcome by plurality, all births, South Australia, 2013

Perinatal outcome
Singleton births Multiple births Total

Number % Number % Number %

Stillbirth 134 0.7 4 0.6 138 0.7

Discharged within 28 days 19,108 97.5 483 72.4 19,591 96.7

In hospital at 28 days 316 1.6 173 25.9 489 2.4

Neonatal death 38 0.2 7 1.0 45 0.2

Total 19,596 100.0 667 100.0 20,263 100.0

Pregnancy Outcome in South Australia 2013page 44

Mothers and Babies



28. Perinatal mortality
High crude perinatal mortality rates were associated with low birthweight births (Table 28a), low gestation births 
(Table 28b) and multiple births (Table 27c).7 The perinatal mortality rate for all births (livebirths of any gestation and 
stillbirths of at least 400g birthweight/20 weeks gestation) in 2013 was 9 per 1,000 births. The stillbirth rate was 6.8 
per 1,000 births and the neonatal mortality rate was 2.2 per 1,000 live births.

The relationship between perinatal mortality and birthweight is demonstrated in Table 28a and Figure 6. The highest 
perinatal mortality rate was observed for the lowest birthweight group weighing &lt;500g (985.9 per 1,000). The 
lowest perinatal mortality rate of 0.6 per 1,000 births was observed for births weighing 4,000 4,499g. The perinatal 
mortality rate for the birthweight group 3,500-3,999g was 0.7 per 1,000 births, and the 4,500+g birthweight group 
was 3.5 per 1000 births. The perinatal mortality rate for babies of normal birthweight (2,500g or more) was 2.1 per 
1,000 births. The decline in perinatal mortality with increasing gestational age is demonstrated in Table 28b.

More detail regarding perinatal mortality is available in the  Maternal, Perinatal and Infant Mortality in South Australia  reports.3

Table 28a: Perinatal mortality by birthweight, all births, South Australia, 2013

Birthweight  
(g)

Total 
births

Live 
births

Stillbirths Neonatal deaths Perinatal deaths

Number
Deaths per 

1,000 births Number

Deaths per 
1,000 live 

births Number
Deaths per 

1,000 births

&lt;400 50 5 45 900.0 5 1,000.0 50 1,000.0

400-499 21 9 12 571.4 8 888.9 20 952.4

500-749 62 34 28 451.6 10 294.1 38 612.9

750-999 67 61 6 89.6 3 49.2 9 134.3

1,000-1,499 137 129 8 58.4 0 0.0 8 58.4

1,500-1,999 339 334 5 14.7 4 12.0 9 26.5

2,000-2,499 876 870 6 6.8 3 3.4 9 10.3

2,500-2,999 3,314 3,305 9 2.7 4 1.2 13 3.9

3,000-3,499 7,386 7,372 14 1.9 6 0.8 20 2.7

3,500-3,999 5,922 5,920 2 0.3 2 0.3 4 0.7

4,000-4,499 1,801 1,800 1 0.6 0 0.0 1 0.6

4,500+ 287 286 1 3.5 0 0.0 1 3.5

Unknown 1 0 1 1,000.0 0 0.0 1 1,000.0

Total 20,263 20,125 138 6.8 45 2.2 183 9.0

Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2013

0.1

1.0

10.0

100.0

1000.0

&lt;5
00

50
0-

75
0-

10
00

-

15
00

-

20
00

-

25
00

-

30
00

-

35
00

-

40
00

-

45
00

+

Birthweight (g)

Pe
ri

n
at

al
 d

ea
th

s 
p

er
 1

,0
00

 b
ir

th
s

(l
o

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it
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 s
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)

Pregnancy Outcome in South Australia 2013 page  45

Mothers and Babies



Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2013

Gestational 
age at birth 
(weeks)

Total 
births

Live 
births

Stillbirths Neonatal deaths Perinatal deaths

Number

Deaths 
per 1,000 

births Number

Deaths per 
1,000 live 

births Number
Deaths per 

1,000 births

&lt;24 101 23 78 772.3 21 913.0 99 980.2

24-27 96 85 11 114.6 5 58.8 16 166.7

28-31 185 177 8 43.2 2 11.3 10 54.1

32-36 1,601 1,585 16 10.0 6 3.8 22 13.7

37-41 18,223 18,199 24 1.3 10 0.5 34 1.9

42+ 56 55 1 17.9 0 0.0 1 17.9

Unknown 1 1 0 0.0 1 1000.0 1 1000.0

TOTAL 20,263 20,125 138 6.8 45 2.2 183 9.0

The perinatal mortality rates for other specified minimum birthweights or gestational ages (where birthweight was 
unavailable) are provided in Table 28c. The perinatal mortality rate recommended by the World Health Organisation 
(WHO) for use in international comparison refers only to stillbirths of at least 1,000g birthweight (or, if birthweight 
is unavailable, 28 weeks gestation) and to (early) neonatal deaths within the first 7 days of life. This rate was 3.2 per 
1,000 births in 2013, with a stillbirth rate of 2.3 per 1,000 births and an early neonatal mortality rate of 0.5 per 1,000 
live births. The perinatal mortality rate for births to Aboriginal women was 15.1 per 1,000 births in 2013 compared 
with 8.8 per 1,000 births for births to non-Aboriginal women (Table 28d). 

Table 28c: Perinatal mortality, South Australia, 2013 (all births of specified birthweight/gestation)

Specified  
birthweight/ 
gestation

Total 
births

Live 
births

Stillbirths Neonatal deaths Perinatal deaths

Number Number Number

Deaths 
per 1,000 

births Number

Deaths 
per 1,000 
live births Number

Deaths 
per 1,000 

births

?400g/20 weeks* 20,263 20,120 138 6.8 45 2.2 183 9.0

?500g/22 weeks 20,191 20,111 80 4.0 32 1.6 112 5.5

(WHO National Statistics) 23 1.1 103 5.1

?1,000g/28 weeks 20,062 20,016 46 2.3 19 0.9 65 3.2

(WHO International 
Statistics)

11** 0.5 57 2.8

* There were 50 births of birthweight &lt;400g  

** only neonatal deaths within the first 7 days of life are included

Pregnancy Outcome in South Australia 2013page 46

Mothers and Babies



Table 28d: Perinatal mortality by race, all births, South Australia, 2013

Race

Total births Stillbirths Neonatal deaths Alive at 28 days Perinatal deaths

Number Number Number Number Number
Deaths per 

1,000 births

Caucasian 15,877 103 32 15,742 135 8.5

Aboriginal 729 7 4 718 11 15.1

Asian 2,422 15 6 2,401 21 8.7

Other 1,235 13 3 1,219 16 13.0

Total 20,263 138 45 20,080 183 9.0

29. Home births
Supplementary Birth Records were received from home birth midwives regarding planned home births for 107 women 
which occurred at home in 2013. There were seven unplanned home births in South Australia in 2013 which have 
been excluded from the planned home birth statistics. All but one of these women received some antenatal care. 
Ascertainment of planned home births occurring at home in South Australia for the year 2013 is estimated to be 
84.3% (107 out of an estimated 127 home births). This estimate has been derived from a comparison with data from 
the Births, Deaths and Marriages Registration Division on births registered, which did not occur in hospital (and were 
not BBAs - babies born before arrival at the hospital into which the woman had been booked). This proportion was a 
marked increase on last year (66.2%) and has returned to pre 2011 ascertainment levels. In addition, 37 women who 
planned to birth at home were transferred to hospital care before birth.  Statistics for all 144 planned home births in 
2013 are provided in Tables 29-32, by place of birth.

Table 29: Planned home births by age of women, South Australia, 2013

Age (years)

Birthed at home Birthed in hospital Total

Number % Number % Number %

&lt;20 1 0.9 0 0.0 1 0.7

20-24 5 4.7 2 5.4 7 4.9

25-29 31 29.0 12 32.4 43 29.9

30-34 35 32.7 12 32.4 47 32.6

35-39 30 28.0 11 29.7 41 28.5

40-44 5 4.7 0 0.0 5 3.5

Total 107 100.0 37 100.0 144 100.0

Pregnancy Outcome in South Australia 2013 page  47

Mothers and Babies



Table 30: Method of birth in planned home births, South Australia, 2013

Method of birth

Birthed at home Birthed in hospital Total

Number % Number % Number %

Normal spontaneous vaginal 105 98.1 20 54.1 125 86.8

Forceps 0 0.0 4 10.8 4 2.8

Elective caesarean section 0 0.0 1 2.7 1 0.7

Emergency caesarean section 0 0.0 11 29.7 11 7.6

Ventouse 0 0.0 1 2.7 1 0.7

Breech spontaneous 2 1.9 0 0.0 2 1.4

Total 107 100.0 37 100.0 144 100.0

Table 31: Birthweight distribution of planned home births, South Australia, 2013

Birthweight (g)

Birthed at home Birthed in hospital Total

Number % Number % Number %

1,500-1,999 1 0.9 0 0.0 1 0.7

2,000-2,499 1 0.9 1 2.7 2 1.4

2,500-2,999 9 8.4 6 16.2 15 10.4

3,000-3,499 26 24.3 11 29.7 37 25.7

3,500-3,999 46 43.0 14 37.8 60 41.7

4,000-4,499 22 20.6 4 10.8 26 18.1

4,500+ 2 1.9 1 2.7 3 2.1

Total 107 100.0 37 100.0 144 100.0

Table 32: Perinatal outcome in planned home births, South Australia, 2013

Perinatal outcome

Birthed at home Birthed in hospital Total

Number % Number % Number %

Stillbirth - - - - - -

Discharged within 28 days 107 100.0 37 100.0 144 100.0

Neonatal death - - - - - -

Total 107 100.0 37 100.0 144 100.0

Pregnancy Outcome in South Australia 2013page 48

Mothers and Babies



30. Birthing unit births
Statistics presented for births in birthing units in South Australia (Tables 33-36) relate to the birthing units at the 
Women s and Children s Hospital, the Lyell McEwin Hospital and Flinders Medical Centre. The units at the Women s 
and Children s Hospital and the Lyell McEwin Hospital were established in 1992 and 1993 respectively under the 
Alternative Birthing Services Programme.  In October 1996 the birthing unit at Flinders Medical Centre commenced 
a birthing service.5 These statistics relate to all 2,327 women for whom it was reported that  birthing unit  was 
their intended place of birth. Of these women, 1,291gave birth in the birthing units while 1,036 women (44.5%) 
gave birth in labour wards. Some of these women were transferred to labour wards because of medical or obstetric 
complications. With the commencement of the Midwifery Group Practice model of care at Women s and Children s 
Hospital in 2004, more of these women who gave birth in labour wards than previously did so because the birthing 
unit was not available at the time. Among the women who gave birth in labour wards, 34.5% had caesarean 
sections and 16.3% had instrumental births. These statistics have also been included in the statistics for the respective 
hospitals. Sixty-three babies (2.7%) were of low birthweight and there were 11 perinatal deaths (perinatal mortality 
rate 4.7 per 1,000 births).

Table 33: Planned birthing unit births by age of women, South Australia, 2013

Age 

(years)

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

&lt;20 55 4.3 53 5.1 108 4.6

20-24 245 19.0 173 16.7 418 18.0

25-29 449 34.8 345 33.3 794 34.1

30-34 384 29.7 297 28.7 681 29.3

35-39 140 10.8 146 14.1 286 12.3

40-44 17 1.3 22 2.1 39 1.7

45+ 1 0.1 0 0.0 1 0.0

Total 1,291 100.0 1,036 100.0 2,327 100.0

Table 34 Method of birth in planned birthing unit births, South Australia, 2013

Method of birth

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

Normal spontaneous vaginal 1,245 96.4 506 48.9 1,751 75.2

Forceps 12 0.9 103 9.9 115 4.9

Assisted breech (no forceps) 0 0.0 1 0.1 1 0.0

Caesarean section (elective) 0 0.0 45 4.3 45 1.9

Caesarean section 

( emergency)

0 0.0 312 30.1 312 13.4

Ventouse 33 2.6 66 6.4 99 4.3

Breech spontaneous 1 0.1 3 0.3 4 0.2

Assisted breech (forceps) 0 0.0 0 0.0 0 0.0

Total 1,291 100.0 1,036 100.0 2,327 100.0

Pregnancy Outcome in South Australia 2013 page  49

Mothers and Babies



Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2013

Birthweight (g)

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

&lt;1,500 0 0.0 15 1.4 15 0.6

1,500-1,999 0 0.0 9 0.9 9 0.4

2,000-2,499 4 0.3 35 3.4 39 1.7

2,500-2,999 156 12.1 132 12.7 288 12.4

3,000-3,499 473 36.6 374 36.0 847 36.4

3,500-3,999 477 36.9 325 31.3 802 34.4

4,000-4,499 160 12.4 122 11.7 282 12.1

4,500+ 21 1.6 26 2.5 47 2.0

Total 1,291 100.0 1,038 100.0 2,329 100.0

Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2013

Perinatal outcome

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

Stillbirth 1 0.1 9 0.9 10 0.4

Discharged within 28 days 1,289 99.8 1,013 97.6 2,302 98.8

Prolonged hospitalisation  (in 
hospital at 28 days)

1 0.1 15 1.4 16 0.7

Neonatal death 0 0.0 1 0.1 1 0.0

Total 1,291 100.0 1,038 100.0 2,329 100.0

Pregnancy Outcome in South Australia 2013page 50

Mothers and Babies



III. Terminations of Pregnancy

1. Numbers and rates
There were 4,681 terminations of pregnancy notified in South Australia in 2013, 84 fewer than in 2012. There were 
14.4 terminations of pregnancy per 1,000 women aged 15-44 years. Following the introduction of specific legislation 
in 1970, the pregnancy termination rate rose to a peak of 13.9 in 1980, followed by a period of relative stability in the 
1980s, with another increase commencing in 1991 which reached a peak of 17.9 in 1999 (Table 1 and Figure 1). The 
rate declined considerably from 17.7 in 2001 to 15.3 in 2005. Since 2012 it has continued to decline.

Table 37: Number* of pregnancy terminations, and rate per 1,000 women aged 15-44 years, South 
Australia, 1970-2013

Year Number Rate Year Number Rate

1970 1,440 6.0 1992 4,717 14.2

1971 2,409 9.6 1993 4,959 15.0

1972 2,692 10.6 1994 5,140 15.7

1973 2,847 11.1 1995 5,475 16.9

1974 2,867 10.9 1996 5,545 17.2

1975 3,000 11.1 1997 5,609 17.5

1976 3,289 11.9 1998 5,488 17.2

1977 3,494 12.4 1999 5,679 17.9

1978 3,895 13.6 2000 5,580 17.6

1979 3,880 13.3 2001 5,579 17.7

1980 4,081 13.9 2002 5,467 17.5

1981 4,096 13.7 2003 5,216 16.7

1982 4,061 13.4 2004 4,931 15.9

1983 4,036 13.1 2005 4,715 15.3

1984 4,091 13.1 2006 4,889 15.5

1985 4,079 12.9 2007 4,885 15.4

1986 4,327 13.5 2008 5,101 16.0

1987 4,229 13.1 2009 5,057 15.6

1988 4,263 13.0 2010 5,048 15.5

1989 4,342 13.2 2011 5,010 15.5

1990 4,463 13.4 2012 4,765 14.7

1991 4,496 14.1 2013 4,681 14.4

*The corrected total numbers of pregnancy terminations notified for the years 1970 to 2012 are shown in Table 37

Figure 7: Pregnancy termination rate per 1,000 women aged 15-44 years, South Australia, 1970-2013

0 

4 

8 

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16 

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Pregnancy Outcome in South Australia 2013 page  51

Terminations of Pregnancy



2. Age of women
The age distribution of women who had pregnancies terminated is shown in Table 38. Among the five- year age 
groups (Table 39), the highest pregnancy termination rate was among women aged 20-24 years (22.8 per 1,000 
women) followed by women aged 25-29 years (20.7 per 1,000 women). Pregnancy termination rates continued to 
fall for teenage women, from 13.7 in 2012 to 12.2 per 1,000 women in 2013. The teenage pregnancy rate (including 
live births and induced abortions) continued to decline, and in 2013 was the lowest on record for the state at 25.3 
per 1,000 women aged 15-19 years compared with 29.1 in 2012. The  abortion proportion  (induced abortion as a 
proportion of induced abortions and live births) was 0.19; it was highest among teenagers (0.48), and was also high 
among women aged 20-24 years (0.30) and older women aged over 45 years (0.23). This indicated that about 48% 
of known teenage pregnancies were terminated. This proportion was highest for younger teenagers (0.60 for those 
aged &lt;15 years).

Table 38: Terminations of pregnancy by age, South Australia, 2013

Age (years) Number
% of terminations  

under 20 years % of all terminations

11 1 0.2 0.0

12 2 0.3 0.0

13 1 0.2 0.0

14 11 1.8 0.2

15 23 3.7 0.5

16 70 11.3 1.5

17 114 18.3 2.4

18 166 26.7 3.5

19 234 37.6 5.0

Sub-total 622 100.0 13.3

Under 15 15 0.3

15-19 607 13.0

20 24 1,271 27.2

25 29 1,167 24.9

30 34 838 17.9

35 39 539 11.5

40 44 214 4.6

45 and over 30 0.6

Total 4,681  100.0

The age distribution of pregnancy terminations and live births by age in South Australia in 2013 (Table 39 and Figure 
8a) demonstrated that the largest proportion of pregnancy terminations occurred in the age group 20-24 years 
(22.8 per 1,000 women), while the largest proportion of live births occurred among those 30-34 years, who had 
the highest fertility (live birth) rate of 124.7 per 1,000 women. Teenagers accounted for 13.3% of women who had 
pregnancies terminated and 3.3% of women who had live births in South Australia in 2013. The teenage pregnancy 
rate continued to decline and was associated with a decline in both the teenage birth and teenage pregnancy 
termination rate (Figure 8b). The teenage pregnancy rate in 2013 was 25.3 per 1,000 women aged 15-19 years, and 
was the lowest rate recorded since 1970.

Pregnancy Outcome in South Australia 2013page 52

Terminations of Pregnancy



Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age, 
South Australia, 2013

Age 
(years)

Number  
of 

termination 
of pregnancy

Estimated 
resident female 

population

August 4 2012*

Termination 
of pregnancy 

rate per 
1,000 women

Number of 
live births#

Fertility 
rate

per 1,000 
women

Termination 
of 

pregnancy  
+ live births

Abortion 
proportion

&lt;15 15           na na 10 na 25 0.60

15-19 607 50,918 12.2  656 13.1  1263 0.48

20-24 1271 55,868 22.8 2897 51.9 4168 0.30

25-29 1167 56,460 20.7 5900 104.5 7067 0.17

30-34 838 53,325 15.7 6650 124.7 7488 0.11

35-39 539 51,246 10.5 3204 62.5 3743 0.14

40-44 214 58,198 4.2  772 13.8  986 0.22

45+ 30 na 31 na 61 0.49

Total 4,681 326,015 14.4 20,120 61.7 24,801 0.19

*Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2013. Canberra: ABS, 2014 (Catalogue No 3235.0).

#Terminations of pregnancy are excluded from the numbers of live births. 

 The termination of pregnancy and live birth rates for women aged 15-19 years include terminations and live births at younger ages, and the rates for 
women aged 40-44 years include terminations and live births at older ages, while the total rates include all terminations and live births.

Figure 8a: Termination of pregnancy and live births by age, South Australia, 2013

0% 

20% 

40% 

60% 

80% 

100% 

Abortions Live births Abortions &amp; Live births 

Pe
rc

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e 

o
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Age (years) 

40+ 35-39 30-34 25-29 20-24 &lt;20 

n=4,681 n=20,120 n=24,801

Pregnancy Outcome in South Australia 2013 page  53

Terminations of Pregnancy



Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2013

0 

10 

20 

30 

40 

50 

60 
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at

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,0
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ea

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Year 

Abortion rate* Birth rate* Pregnancy rate* 

*Abortions and births to women aged less than 15 years are included in the numerator

3. Place of residence and place where termination performed
The proportion of women who were country residents (18.7%) was similar to previous years. As in previous years, 
the proportion of pregnancy terminations performed in country hospitals (2.2%) was lower, relative to the proportion 
of country residents having terminations, indicating that the majority of country residents have their terminations in 
metropolitan hospitals (Table 40).

Table 40: Terminations by place of residence, South Australia, 2013

Residence of women Number %

Metropolitan 3,790 81.3

Country 874 18.7

Total 4,664 100.0

As in previous years, the vast majority of terminations (97.0%) were performed in metropolitan public hospitals, 
including 59.2% (2,771) at the Pregnancy Advisory Centre (Table 41).

Table 41: Terminations by hospital category, South Australia, 2013

Hospital where termination performed Number %

Metropolitan public 4,540 97.0

Metropolitan private 40 0.9

Country 101 2.2

Total 4,681 100.0

Doctors in family advisory clinics in teaching hospitals and the Pregnancy Advisory Centre performed 77.1% of 
the terminations. Elsewhere, obstetricians and trainee obstetricians performed 21.2%, while general practitioners 
performed 1.6% (Table 42).

Pregnancy Outcome in South Australia 2013page 54

Terminations of Pregnancy



Table 42:  Terminations by category of doctor, South Australia, 2013

Category of doctor performing termination Number %

Medical practitioner in family advisory clinic 3,611 77.1

Obstetrician/gynaecologist 674 14.4

Trainee obstetrician/gynaecologist 319 6.8

General practitioner 77 1.6

Total 4,681 100.0

4. The reason for termination
The pattern of reasons for termination of pregnancy remained similar to previous years, with 96.1% being performed 
for the woman s mental health, 3.4% for serious handicap of the fetus and 0.6% for specified medical conditions. Of 
the 157 terminations for fetal reasons, 69 were for chromosomal abnormalities and 82 for other fetal abnormalities 
detected or suspected prenatally. Six were performed for exposure during pregnancy to drugs, which may cause fetal 
abnormalities (Table 43).

Table 43:  Reason for termination for fetal reasons, South Australia, 2013

Reason for termination Number %

Identified chromosomal abnormality 82 52.2

Other identified fetal abnormality 69 43.9

Possibility of damage from drugs 6 3.8

Total 157 100.0

5. Gestation, method and complications
The majority of terminations (91.9%) were performed within the first 14 weeks of pregnancy and most frequently (in 
50.4% of cases) by vacuum aspiration. There were 94 terminations performed at 20 weeks gestation or later: 50.0% 
of these were performed for fetal reasons. 

Tables 44a and 44b report complications by the number of women undergoing termination procedures (4,681), which 
included one failed procedure. 

There were 115 (2.5%) women who experienced complications related to a pregnancy termination. Fourteen (12.2%) 
of these were reported on the abortion notification form, and 101 (87.8%) were identified through validation with 
hospital admission statistics from the South Australian hospital morbidity collection, using codes for pregnancy 
termination for women admitted in to hospital. The notification form tends to identify more immediate complications.

The main complication reported was retained products of conception (99 cases). Of the 77 women with complications 
reported following termination with mifepristone +/- misoprostol, 74 (96.1%) were due to retained products. 

Pregnancy Outcome in South Australia 2013 page  55

Terminations of Pregnancy



Table 44a: Complications of termination procedures, South Australia, 2013

Complication
Number of 

complications % of complications
% of all termination 

procedures

Retained products of conception 99 86.1 2.1

Uterine infection 8 7.0 0.2

Bleeding 1 0.9 0.0

Sepsis 1 0.9 0.0

Haemorrhage post-operative 1 0.9 0.0

Haemorrhage intra-operative 1 0.9 0.0

Failed procedure 1 0.9 0.0

Other 3 2.6 0.1

Total 115 100.0 2.5

Table 44b: Complications by method of termination procedure, South Australia, 2013

Method of termination
Number of women  
with complications

Number of  
termination procedures

% of termination 
procedure with 

complications by method

Mifepristone +/- Misoprostol 77 1,245 6.2

Vacuum aspiration 20 2,358 0.8

Dilatation and curettage 7 629 1.1

Cervagem / Misoprostol 5 38 13.2

Dilatation and evacuation 3 384 0.8

Misoprostol 3 26 11.5

Other 0 1 0.0

Total 115 4,681 2.5

Pregnancy Outcome in South Australia 2013page 56

Terminations of Pregnancy



6. Previous terminations. Total termination of pregnancy rate and total first 
termination of pregnancy rate
Of the 4,681 women who had terminations, 1,684 (36.0%) had undergone a previous termination (Table 45a). 
Among the teenagers 14.3% had a previous termination; 31.4% of women aged 20-24 years and 46.8% of women 
aged 35-39 years had undergone a previous termination. 

The total induced abortion rate (TAR) is the sum of pregnancy termination rates for each of the five-year age groups 
multiplied by five. This can be calculated using the rates in Table 39 and in 2013 was 430.3 per 1,000 women aged 
15-44 (Table 45b). This represents the number of induced abortions 1,000 women would have during their lifetime if 
they experienced the induced abortion rates of the different age groups for 2013.

A woman may have more than one termination of pregnancy in her lifetime, and to estimate how prevalent 
termination of pregnancy is at these age-specific induced abortion rates, a total first induced abortion rate (TFAR, 
Table 45c) may be calculated after excluding women with repeat terminations. The TFAR for 2013 was 276.1 per 
1,000 women aged 15-44 years. This suggests that 27.6% of women would have a termination of pregnancy in their 
lifetime if they experienced the termination of pregnancy rates of the different age groups for 2013.

Table 45a: Women with previous terminations by age, South Australia, 2013

Age (years) Number % of age group % of all terminations

&lt; 15 0 0.0 0.0

15 - 19 87 5.2 1.9

20 - 24 399 23.7 8.5

25 - 29 489 29.0 10.4

30 - 34 350 20.8 7.5

35 - 39 252 15.0 5.4

40+ 107 6.4 2.3

Total 1,684 100.0 36.0

Further details of termination of pregnancy in South Australia in 2013 may be obtained from the Eleventh Annual 
Report of the South Australian Abortion Reporting Committee   for the year 2013.6

Pregnancy Outcome in South Australia 2013 page  57

Terminations of Pregnancy



Table 45b: Calculation of total induced abortion rate (TAR), South Australia, 2013*

Age (years)
Number of women  

who had terminations
Estimated female resident  

population 30 June 2013
Termination of pregnancy 

rate per 1,000 women

15-19* 622 51,239 12.2

20-24 1,271 56,050 22.8

25-29 1,167 56,064 20.7

30-34 838 51,702 15.7

35-39 539 52,013 10.5

40-44* 244 58,138 4.2

Total 4,681 325,206 14.4

*In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 yrs and termination of pregnancy for 
women aged 45 years or more are included in the age group 40-44 years, as is traditional.

Total induced abortion rate (TAR) = sum of termination of pregnancy rates for 5-year age groups x 5 = 86.1 x 5 = 430.3 per 1,000 women aged 
15-44 years.

Table 45c: Calculation of total first induced abortion rate (TFAR), South Australia, 2013

Age 
(years)

Number of 
women who had 

terminations

(A)

Number of women 
who had previous 

terminations

(B)

Number of women 
who had first 

termination

(A)   (B)

Estimated 
female resident 

population 
30 June 2013*

First termination 
of pregnancy 

rate per 1,000 
women

15-19 622 87 535 50,918 10.5

20-24 1,271 399 872 55,868 15.6

25-29 1,167 489 678 56,460 12.0

30-34 838 350 488 53,325 9.2

35-39 539 252 287 51,246 5.6

40-44 244 107 137 58,198 2.4

Total 4,681 1,684 2,997 326,015 9.2

* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 30 June 2013. Canberra: ABS, 2014 (Catalogue No 3235.0). 

 In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 years and termination of pregnancy for 
women aged 45 years or more are included in the age group 40-44 years.

Total first induced abortion rate (TFAR) = sum of first termination of pregnancy rates for 5-year age groups x 5 = 55.2 x 5 = 276.1 per 1,000 women 
aged 15-44 yrs. 

Pregnancy Outcome in South Australia 2013page 58

Terminations of Pregnancy



IV. Obstetric Profiles by Hospital Category
Obstetric profiles for the three major metropolitan public hospitals and three hospital categories for 2013 are provided 
in Table 46 and Figures 9-28. They were also reported for hospital categories and individual hospitals in the Pregnancy 
and Neonatal Care Bulletins.

These hospital categories as determined by their Perinatal Service Delineation are:

1. The Women s &amp; Children s Hospital,

2. Flinders Medical Centre, (both the Women s and Children s Hospital and Flinders Medical Centre have neonatal 
intensive care facilities)

3. The  Lyell McEwin Hospital,

4. Metropolitan private hospitals,

5. The two Level 4:4 country hospitals (Mount Gambier and Port Augusta) and

6. Other country hospitals (Perinatal Service Delineation of 3:3). 

One mother who gave birth at the Royal Adelaide Hospital has been excluded from these hospital category statistics.

A list of maternal and baby factors identified either as risk factors for poor perinatal outcome in earlier analyses, 7 or 
of general interest, is provided with  means  for all state hospital births as well as proportions for the six hospital 
categories.

The  mean  is the proportion for women who gave birth in all state hospitals (for maternal factors) or births in all 
state hospitals (for baby factors),

e.g. % Aboriginal women 

x100
    Total number of women who gave birth in state hospitals

    Number of Aboriginal  women who gave birth in state hospitals

Where indicated (+) in Table 46, it is the mean (number of women who gave birth, or births) for the 22 hospitals 
or groups of hospitals for which obstetric profiles have been provided, and which have also been included in the 
provision of the 10th and 90th percentile values. These are as follows:

  1. Women s &amp; Children s Hospital

  2. Flinders Medical Centre

  3. Lyell McEwin Hospital

  4. Ashford Hospital 

  5. Burnside War Memorial Hospital Inc

  6. Calvary Healthcare Adelaide

  7. Flinders Private Hospital

  8. North Eastern Community Hospital

  9. Mount Gambier &amp; District Health Service Inc

10. Port Augusta Hospital &amp; Regional Health Service Inc

11. Barossa Health (Tanunda Centre)

12. Gawler Health Service

13. Loxton Hospital

14. Mount Barker District Soldiers  Memorial Hospital Inc

15. Murray Bridge Soldiers  Memorial Hospital Inc

16. Naracoorte Health Service Inc

17. Northern Yorke Peninsula Regional Health Service (Wallaroo)

Pregnancy Outcome in South Australia 2013 page  59

Obstetric Profiles by Hospital Category



18. Port Lincoln Health Service Inc

19. Port Pirie Regional Health Service Inc

20. Riverland General Hospital  (Berri)

21. The Whyalla Hospital &amp; Health Services Inc

22. Country hospitals with &lt;100 births per year

The 10th percentile is the proportion below which 10% of the 22 hospital proportions, i.e. the two lowest hospital 
proportions, would be found if the 22 proportions were ranked from highest to lowest. The 90th percentile is the 
proportion above which 10% of the 22 hospital proportions, i.e. the two highest proportions, would be found if the 
22 proportions were ranked from highest to lowest. As the two Level III hospitals which account for 41.8% of hospital 
births have proportions of some factors (such as prolonged hospitalisation and use of neonatal intensive care) which 
are much greater than for the other 20 hospitals, occasionally the mean for all hospitals will be seen to be higher than 
the 90th percentile.

The table and figures provide obstetric profiles for the three major metropolitan public hospitals and three hospital 
categories. These have been provided since 1986 to hospitals with 100 or more births per year, together with their 
individual hospital profiles, including crude and standardized perinatal mortality ratios,8 the latter with exclusion of 
perinatal deaths from congenital abnormalities3 and terminations of pregnancy. For country hospitals with less than 
100 births per year, a group report has been provided.

Each hospital s statistics for each factor may be compared with those for state hospitals and for categories of 
hospitals, e.g. whether a hospital s proportion for any factor falls within the range of the more common proportions 
prevailing in hospitals in the state (i.e. between the 10th and the 90th percentiles).

Pregnancy Outcome in South Australia 2013page 60

Obstetric Profiles by Hospital Category



Table 46:  Obstetric profiles by hospital category, South Australia, 2013: live births and stillbirths of &gt;=400g 
or &gt;=20 weeks gestation#

Factors

All state hospitals Metropolitan hospitals Country hospitals

Mean 10th percentile
90th 

percentile W&amp;CH FMC LMH Private
Level 

4:4 Other

Maternal factors

Women (n= 19,810) 900+ 143 3,298 4,740 3,322 3,298 4,543 852 3,055

% Aboriginal women 3.6 0.2 9.8 4.4 2.8 4.5 0.2 11.9 5.1

% Antenatal visits &lt;7* 8.7 0.7 12.0 14.7 12.0 11.7 0.6 6.6 5.5

% Teenage women 3.4 0.0 10.3 2.7 4.0 5.6 0.0 4.3 5.8

% Women ?35 years 19.7 10.5 29.4 21.4 16.5 12.2 30.8 13.7 13.9

% Single women 10.2 1.7 17.8 16.3 8.8 13.3 1.7 12.7 10.5

% 4+ prior live births 2.9 0.4 6.3 3.5 2.0 5.3 0.5 4.9 3.7

% 1+ prior perinatal deaths 1.3 0.6 1.7 1.9 1.4 1.7 0.7 0.5 1.1

% Obstetric complications 39.6 23.4 44.6 44.6 52 44.5 29.9 39.9 27.5

% Labour complications 38.1 25.0 38.6 48.7 49.4 38.6 25.7 27.3 30.2

% Induction 32.7 25.2 36 36 31.4 30.7 34.8 32 28.1

% Emergency caesarean 17.9 9.9 22.1 18.6 20.9 18.5 17.1 16.4 14.4

% Elective caesarean 16.3 11.8 23.3 11.7 16.0 14.0 24.5 17.0 14.1

% Total caesarean 34.2 26.2 42.6 30.2 36.9 32.5 41.6 33.5 28.4

% Ultrasound 
examination* 97.6 94.2 98.6 98.6 99.0 98.2 96.5 95.8 96.1

% Amniocentesis* 3.4 0.9 4.4 5.0 2.6 2.9 3.6 2.9 2.2

% Episiotomy 13.4 4.0 17.2 15.5 12.4 12.7 17.0 5.4 8.8

% Repair of perineal tear 26.6 18.2 32.4 32.5 25.1 22.4 27.0 21.8 24.6

% Epidural analgesia 31.5 13.8 43.4 37.3 26.1 26.5 43.7 19.2 18.9

% Spinal analgesia 1.0 0.0 1.7 0.5 0.8 1.4 1.2 0.7 1.3

% Private patients 27.2 1.3 100.0 7.3 1.3 1.1 100.0 17.8 9.0

% Primiparous women 43.5 35.1 47.0 46.6 47 39.6 45.6 38.6 37.2

% Previous caesarean 17.5 13.8 22.4 15.7 16.4 17.1 21.2 18.2 16.2

% PPH 12.5 3.4 15.4 20.6 12.7 13.6 5.4 8.6 10.0

Baby factors 

Births (n= 20,148) 916+ 143 3333 4,891 3,384 3,333 4,622 860 3,058

% Birthweight &lt;2,500g 7.7 0.8 7.5 14.4 9.9 6.2 4.2 5.5 2.0

% Gestational age  
&lt;37 weeks at birth 9.8 0.9 9.4 16.8 12.5 8.9 7.0 7.4 1.6

% Prolonged 
hospitalisation (&gt;27 days) 2.4 0.0 2.8 5.6 3.8 0.8 1.1 1.2 0.1

% Neonatal intensive  
care (Level  III or W&amp;CH  
paediatric intensive care)

2.8 0.0 2.4 6.4 4.5 1.0 1.0 1.0 0.6

% Birth defect 2.8 0.7 3.0 5.1 2.5 2.8 1.3 2.7 1.7

* adjusted for missing values

+ mean number of women who gave birth, or mean number of births for the 22 hospitals or groups of hospitals

# 1 mother who gave birth at the RAH has been excluded from this table 

Pregnancy Outcome in South Australia 2013 page  61

Obstetric Profiles by Hospital Category



Figure 9: Percentage of Aboriginal women by hospital category

0 
2 
4 
6 
8 

10 
12 
14 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 10: Percentage of women with &lt;7 antenatal visits by hospital category

0.0 
2.0 
4.0 
6.0 
8.0 

10.0 
12.0 
14.0 
16.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 11: Percentage of teenage women by hospital category

0.0 

2.0 

4.0 

6.0 

8.0 

10.0 

12.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Pregnancy Outcome in South Australia 2013page 62

Obstetric Profiles by Hospital Category



Figure 12: Percentage of women 35 years or more by hospital category

0.0 
5.0 

10.0 
15.0 
20.0 
25.0 
30.0 
35.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 13: Percentage of single women by hospital category

0.0 
2.0 
4.0 
6.0 
8.0 

10.0 
12.0 
14.0 
16.0 
18.0 
20.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 14: Percentage of women with 4 or more prior livebirths by hospital category

0.0 

1.0 

2.0 

3.0 

4.0 

5.0 

6.0 

7.0 

8.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Pregnancy Outcome in South Australia 2013 page  63

Obstetric Profiles by Hospital Category



Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category

0.0 

0.5 

1.0 

1.5 

2.0 

2.5 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 16: Percentage of women with obstetric complications by hospital category

0.0 

10.0 

20.0 

30.0 

40.0 

50.0 

60.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

10th percentile 

90th percentile 
Mean 

Figure 17: Percentage of women with complications during labour or birth by hospital category

0.0 

10.0 

20.0 

30.0 

40.0 

50.0 

60.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Pregnancy Outcome in South Australia 2013page 64

Obstetric Profiles by Hospital Category



Figure 18: Percentage of women with induction of labour by hospital category

0.0 

10.0 

20.0 

30.0 

40.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 19: Percentage of women having epidural analgesia by hospital category

0.0 

10.0 

20.0 

30.0 

40.0 

50.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 20: Percentage of breech births by hospital category

0 
0.1 
0.2 
0.3 
0.4 
0.5 
0.6 
0.7 
0.8 
0.9 

1 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Pregnancy Outcome in South Australia 2013 page  65

Obstetric Profiles by Hospital Category



Figure 21: Percentage of emergency caesarean sections by hospital category

0.0 

5.0 

10.0 

15.0 

20.0 

25.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 
Mean 

10th percentile 

Figure 22: Percentage of elective caesarean sections by hospital category

0.0 

5.0 

10.0 

15.0 

20.0 

25.0 

30.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 23: Percentage of total caesarean sections by hospital category

0.0 
5.0 

10.0 
15.0 
20.0 
25.0 
30.0 
35.0 
40.0 
45.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 

Mean 

10th percentile 

Figure 24: Percentage of births with birthweight below 2,500g by hospital category

0.0 
2.0 
4.0 
6.0 
8.0 

10.0 
12.0 
14.0 
16.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 
Mean 
 

10th percentile 

Pregnancy Outcome in South Australia 2013page 66

Obstetric Profiles by Hospital Category



Figure 25: Percentage of births with gestation less than 37 weeks by hospital category

0.0 
2.0 
4.0 
6.0 
8.0 

10.0 
12.0 
14.0 
16.0 
18.0 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

90th percentile 
Mean 

10th percentile 

Figure 26: Percentage of births with prolonged hospitalisation by hospital category

0 

1 

2 

3 

4 

5 

6 

1 2 3 4 5 6 

Pe
rc

en
ta

g
e 

Hospital category 

10th percentile 

 
90th percentile 
Mean 

 

Figure 27: Percentage of live births requiring neonatal intensive care by hospital category

0

1

2

3

4

5

6

1 2 3 4 5 6

Hospital category

Pe
rc

en
ta

g
e

Mean

10th percentile

90th percentile

Figure 28: Percentage of births with birth defects by hospital category

1 2 3 4 5 6

Hospital category

0

1

2

3

4

5

Pe
rc

en
ta

g
e

10th percentile

90th percentile
Mean

Pregnancy Outcome in South Australia 2013 page  67

Obstetric Profiles by Hospital Category



V. Clinical and Maternity Performance Indicators

1. Clinical indicators

Ten national core maternity indicators have been developed to examine trends in maternity interventions and 
outcomes and the quality of maternity services in the years after the introduction of the National Maternity Services 
Plan. 9 This report presents these indicators with 95% Confidence Intervals (CI) for South Australian births in 2013. 
They were also reported for individual hospitals in the Pregnancy and Neonatal Care Bulletin 2013. Indicator 
specifications are in accordance with the 2013 National Core Maternity Indicators report. 10

For the purpose of Indicators 5, 6 and 8  selected primiparae  was defined as:

 &gt; a woman who was 20-34 years of age at the time of giving birth

 &gt; giving birth for the first time at ?20 weeks of gestation

 &gt; singleton pregnancy

 &gt; cephalic presentation

 &gt; at 37 to 41 weeks gestation.

INDICATOR 1: Smoking in pregnancy 

Description: This indicator has two parts: (a) among all women who gave birth, the proportion who reported smoking 
tobacco at any time within the first 20 weeks of pregnancy; and (b) among women who reported smoking, the 
proportion who reported smoking after 20 weeks of pregnancy.

Purpose: This indicator is used to monitor public health and assess the effectiveness of smoking cessation advice in the 
antenatal period in the antenatal period. 

 &gt; Clinical indicator 1a: Total number of women smoking in first 20 weeks of pregnancy.

Numerator:  The number of women who gave birth and reported smoking tobacco in the first 20 weeks of pregnancy 
(n=2,857).

Denominator:  The total number of women who gave birth (n=19,925).

Clinical indicator 1a = 
 2,857 x 100

19,925
=14.3%   (95% CI 13.9% - 14.8%).

 &gt; Clinical indicator 1b: Proportion of women who smoked in first 20 weeks of pregnancy and continued to 
smoke in the second 20 weeks of pregnancy. 

Numerator:  The number of women who gave birth and reported smoking tobacco in the second 20 weeks of 
pregnancy (n= 1,911).

Denominator:  The number of women who gave birth who reported smoking tobacco at any time in the pregnancy 
(n= 2,857).

Clinical indicator 1b = 
  1,911 x 100

2,857
= 66.9% (95% CI 65.1%   68.6%). 

Pregnancy Outcome in South Australia 2013page 68

Clinical and Maternity Performance Indicators



INDICATOR 2: Antenatal care in the first trimester for all women giving birth

Description: Among all women who gave birth, the proportion who commenced antenatal care in the first trimester 
(before 14 weeks gestation).

Purpose: This indicator is used to assess the accessibility of antenatal services.

 &gt; Clinical indicator 2: Antenatal care in the first trimester for all women giving birth

Numerator:  The number of women who had their first antenatal visit before 14 weeks gestation and went on to give 
birth (n=15,240).

Denominator:  The number of all women who gave birth (n=19,925).

Clinical indicator 2 =
19,925

15,240 x 100
= 76.5%  (95% CI 75.9% - 77.1%).

INDICATOR 3: Episiotomy for women having their first baby and giving birth vaginally

Description: This indicator has two parts among women who had their first baby: (a) the proportion who received an 
episiotomy while giving birth vaginally without instruments; and (b) the proportion who received an episiotomy during 
an instrumental vaginal birth.

Purpose: This indicator is used to benchmark practice. 

 &gt; Clinical indicator 3a: Total number of women having their first baby who gave birth vaginally without 
instruments and had an episiotomy

Numerator: The number of women having their first baby who had an episiotomy while giving birth vaginally without 
instruments (n=735)

Denominator: The number of women having their first baby who gave birth vaginally without instruments (n=3,791)

Clinical indicator 3a = 
3,791

  735 x 100  = 19.4% (95% CI 18.2% - 20.7%).

 &gt; Clinical indicator 3b: Total number of women having their first baby who gave birth vaginally with 
instrumental assistance and had an episiotomy

Numerator: The number of women having their first baby who had an episiotomy during a vaginal birth with 
instruments (n=1,258)

Denominator: The number of women having their first baby who gave birth vaginally with instruments (n=1,825)

Clinical indicator 3b = 
1,825

1,258 x 100  = 68.9% (95% CI 66.8% - 71.0%).

Pregnancy Outcome in South Australia 2013 page  69

Clinical and Maternity Performance Indicators



INDICATOR 4: Apgar score of less than 7 at 5 minutes for births at or after term

Description: The proportion of liveborn term infants with an Apgar score of less than 7 at 5 minutes.

Purpose: This indicator of the condition of the baby after birth provides an outcome measure of intrapartum care and 
resuscitation of the newborn.

 &gt; Clinical indicator 4: Apgar score of less than 7 at 5 minutes for births at or after term

Numerator: The number of babies born alive at term with an Apgar score less than 7 at 5 minutes (n=221).

Denominator: The number of live babies born at term (n=18,255).

Clinical indicator 4 = 
18,255

221 x 100  = 1.2% (95% CI 1.1% - 1.4%).

INDICATOR 5: Induction of labour for selected primiparae

Description: The proportion of all selected primiparae, whose labour was induced.

Purpose: This indicator is used to benchmark practice.

 &gt; Clinical indicator 5: Induction of labour for selected women giving birth for the first time

Numerator: The number of selected primiparae who had labour induced (n=2,492).

Denominator:  All selected women giving birth for the first time (n=5,961).

Clinical indicator 5 = 
5,961

2,492 x 100  = 41.8% (95% CI 40.6% - 43.1%).

INDICATOR 6: Caesarean section for selected primiparae

Description: The proportion of all selected primiparae who gave birth by caesarean section.

Purpose: This indicator is used to benchmark practice.

 &gt; Clinical indicator 6: Caesarean section for selected primiparae

Numerator: The number of selected primiparae who gave birth by caesarean section (n=1,714).

Denominator: All selected primiparae (n=5,961).

Clinical indicator 6 = 
5,961

1,714 x 100  = 28.8% (95% CI 27.6% - 29.9%).

INDICATOR 7: Normal (non-instrumental) vaginal birth for selected primiparae

Description: The proportion of all selected primiparae, who had a normal (non-instrumental) vaginal birth.

Purpose: This indicator is used to benchmark practice.

 &gt; Clinical indicator 7: Normal (non-instrumental) vaginal birth for selected primiparae

Numerator: The number of selected primiparae who had a normal (non-instrumental) vaginal birth (n=2,803).

Denominator: All selected primiparae (n=5,961).

Clinical indicator 7 = 
5,961

  2,803 x 100  = 47.0% (95% CI 45.8% - 48.3%).

Pregnancy Outcome in South Australia 2013page 70

Clinical and Maternity Performance Indicators



INDICATOR 8: Instrumental vaginal birth for selected primiparae

Description: The proportion of all selected primiparae, who had a vaginal birth with the assistance of instruments.

Purpose: This indicator is used to benchmark practice.

 &gt; Clinical indicator 8: Instrumental vaginal birth for selected primiparae

Numerator: The number of selected primiparae who had a vaginal birth with the assistance of instruments (n=1,444).

Denominator: All selected primiparae (n=5,961).

Clinical indicator 8 = 
5,961

1,444 x 100
 = 24.2% (95% CI 23.2% - 25.3%).

INDICATOR 9: General anaesthetic for women giving birth by caesarean section

Description: The proportion of women who gave birth by caesarean section who received a general anaesthetic.

Purpose: This indicator is used to benchmark anaesthetic care in association with caesarean section.

 &gt; Clinical indicator 9: General anaesthetic for women giving birth by caesarean section

Numerator: The number of women who gave birth by caesarean section and had a general anaesthetic (n=400).

Denominator: The total number of women who gave birth by caesarean section (n=6,778).

Clinical indicator 9 = 
  400 x 100
6,778

= 5.9%  (95% CI 5.4% - 6.5%).

INDICATOR 10: Small babies among births at or after 40 weeks gestation

Description: The proportion of babies born at or after 40 weeks gestation who weighed less than 2,750 grams at 
birth.

Purpose: This indicator aims to identify intrauterine growth restriction for babies born at or after 40 weeks gestation. 
This indicator is used to benchmark practice.

 &gt; Clinical indicator 10.1: Small babies among births at or after 40 weeks gestation

Numerator: The number of babies born at or after 40 weeks gestation who weighed less than 2,750 grams at birth 
(n=110).

Denominator:  The total number of babies born at or after 40 weeks (n=7,148).

Clinical indicator 10 = 
110 x 100

7,148
= 1.5%  (95% CI 1.3% - 1.9%).

Pregnancy Outcome in South Australia 2013 page  71

Clinical and Maternity Performance Indicators



2. Maternity performance indicators, hospitals with at least 550 births per year

Six clinical indicators are presented below. Five are selected from The Australian Council on Healthcare Standards 
( ACHS  Clinical Indicator Users  Manual Version 2010 ) and are presented for hospitals with at least 550 births per 
year. Additionally, the sixth indicator presents the standardized perinatal mortality ratio.

These six indicators are as follows:

1. Proportion of selected primiparae who underwent induction of labour.

This was as defined for Clinical indicator 5 and was 41.9% for the state in 2013 (and 41.8% for state hospitals) in 2013.

2. Caesarean section rate for selected primiparae.

This was as defined for Clinical indicator 6 and was 28.8% for the state (as well as state hospitals) for 2013.

3. VBAC: proportion of women who gave birth vaginally following a previous primary (first) caesarean 
section and no intervening births.

Numerator: Total number of women giving birth vaginally following a previous primary caesarean section (n=386).

Denominator: Total number of women giving birth who have had a previous primary caesarean section and NO 
intervening pregnancies greater than 20 weeks gestation (n=2,480).

This was as defined as above and was 15.6% for the state (and 15.5% for state hospitals) in 2013.

4. Proportion of selected primiparae with an intact perineum following vaginal birth.

Numerator: Total number of selected primiparae with an intact perineum (n=355).

Denominator: Total number of selected primiparae giving birth vaginally (n=4,247).

This was as defined as above and was 8.4% for the state (and 8.2% for state hospitals) in 2013.

5. TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for reasons other than 
congenital abnormality.

Numerator: The number of term babies (37 weeks gestation or later) transferred/admitted to a neonatal intensive care 
unit for reasons other than congenital abnormality (n=91).

Denominator: The total number of term live babies born (n=18,255).

This was as defined as above and was 0.5% for the state (as well as state hospitals) in 2013.

6. SPMR: Standardized perinatal mortality ratio for all births.

This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2012. It adjusts for the difference between the 
distribution of births by birthweight between the hospital and state hospital births. As perinatal mortality is much 
higher in babies of low birthweight, this adjustment ensures that a hospital is directly comparable with other hospitals 
and state hospitals as a whole if it has a higher proportion of low birthweight babies than state hospital births.

SPMR = 
Expected number of deaths

Observed number of deaths 
 X 100

To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality rate for 2013 for each 
of the birthweight groups in Table 28a is applied to the number of births in each corresponding birthweight group 
for the hospital. This gives an expected number of deaths in each birthweight group. These expected deaths are then 
totalled to give a total number of expected deaths for the hospital.

SPMRs provided in this report exclude deaths attributed to congenital abnormalities (as determined by the Maternal, 
Perinatal and Infant Mortality Committee3), which are the least preventable, as well as terminations of pregnancy. 
An SPMR above 100 means that after adjustment for birthweight differences and deaths attributed to congenital 
abnormalities and terminations of pregnancy, perinatal mortality for that hospital is higher than that for state hospital 
births e.g. an adjusted SPMR of 120 means that it is 20% higher.

Pregnancy Outcome in South Australia 2013page 72

Clinical and Maternity Performance Indicators



A 95% confidence interval (CI) which includes the value 100 in its range means that the hospital s perinatal mortality 
is not (statistically) significantly different from that for state hospital births for that year. The SPMRs and 95% CIs for 
individual hospitals and categories of hospitals have been programmed using indirect standardization methods.8

Statistics for the six maternity performance indicators for 2013 are provided in Figures 29a   29f for the nine 
hospitals, A   I, with at least 550 births in 2013. SPMRs for the preceding five years combined, 2009-2013, are 
provided in Figure 29G. Metropolitan teaching hospitals and Mount Gambier Hospital have been named with their 
permission and are as follows:

A.  Women s and Children s

B.  Flinders Medical Centre

C.  Lyell McEwin Hospital

D.  Mt Gambier Hospital

  

Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals  
with &gt;=550 births per year, 2013

0 

10 

20 

30 

40 

50 

A B C D E F G H I 

%
 

Hospital 

Induction of labour %  *SA hospitals = 41.9% 

Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with &gt;=550 births per year, 2013

0 

10 

20 

30 

40 

50 

60 

A B C D E F G H I 

%
 

Hospital 

Caesarean section % *SA hospitals = 28.8% 

Pregnancy Outcome in South Australia 2013 page  73

Clinical and Maternity Performance Indicators



Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first) 
caesarean section &amp; no intervening births, SA hospitals with &gt;=550 births per year, 2013

0 

10 

20 

30 

40 

A B C D E F G H I 

%
 

Hospital 

VBAC % *SA hospitals = 15.5% 

Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals 
with &gt;=550 births per year, 2013

0 

10 

20 

30 

40 

A B C D E F G H I 

%
 

Hospital 
Primip no repair %  *SA Hospitals = 8.2% 

Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital 
abnormality, SA hospitals with &gt;=550 births per year, 2013

0.0 

0.2 

0.4 

0.6 

0.8 

1.0 

1.2 

1.4 

A B C D E F G H I 

%
 

Hospital 

Term NICU %  *SA hospitals = 0.5% 

Pregnancy Outcome in South Australia 2013page 74

Clinical and Maternity Performance Indicators



Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=550 births per 
year, 2013

0 

50 

100 

150 

200 

250 

300 

A B C D E F G H I 

Hospital 

SPMR *SA hospitals  

Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=550 births per 
year, 2008-2013

0

50

100

150

200

A B C D E F G H I

Hospital

SPMR *SA hospitals

Pregnancy Outcome in South Australia 2013 page  75

Clinical and Maternity Performance Indicators



VI. Trends in Perinatal Statistics in South Australia, 1981-2013
Perinatal statistics are presented in Tables 47 and 48 for both socio-demographic and obstetric aspects for each 
year from 2003-2013, as well as for 1981, when the perinatal data collection was commenced. Some features are 
illustrated in Fig 30.1   30.8 for the years 1985-2013. The trends noted between 1981 and 2013 are as follows:

1 The total fertility rate was 1.85 live births per woman, following a steady increase from 1.71 in 2000 to 1.91 live 
births per woman in 2008, 2009 and 2012.

2 The increase in the proportion of Asian women from 1.8% in 1981 to 12.0% in 2013 and of Aboriginal women 
from 1.5% in 1981 to 3.6% in 2013.

3 The decrease in the proportion of teenage women giving birth from 7.8% in 1981 to 3.3% in 2013. Over the 
past decade, there has been a general decline in both the teenage birth and abortion rate. The teenage pregnancy 
rate in 2013 of 25.3 per 1,000 women was the lowest recorded since 1970, when abortion statistics were first 
collected, enabling calculation of a pregnancy rate.

4 The increase in the age of women giving birth. The proportion of women who gave birth who were 35 years or 
older increased from 4.6% in 1981 to 19.8% in 2013, following a peak of 21.1% in 2008 and 2009. Amongst 
primiparous women the proportion in 1981 was 1.2%, and in 2013 it was 12.4%. (It was 12.8% in 2009). The 
mean age among women giving birth increased from 26.55 years in 1981 to peak in 2012 at 30.21 years; in 2013 
it was 29.8 years. The mean age among primiparous women which went from 24.42 years in 1981 and peaked in 
2012 at 28.44 years remained steady at 28.2 years in 2013.

5 The proportion of single women giving birth peaked in 1996 at 14.9%, since which time there has been a gradual 
decrease and was 10.1% in 2013.

6 The proportion of births in country hospitals has gradually declined from 27.8 in 1981 to 24.9% in 1997 and was 
19.3% in 2013. The proportion of births in teaching hospitals gradually increased to 57.8% in 2013 following a low of 
47.2% in 1991. In 2013 metropolitan private hospitals accounted for 22.8% of births. The number of births in birthing 
units in teaching hospitals increased from 125 (0.6%) in 1992 to 1,291 (6.4%) in 2013. Home births increased from 
44 (0.2%) in 1997 to 144 (0.7%) in 2010. The decrease in the reporting of homebirths noted in 2011 (64.4%) and 
2012 (66.2%) has improved with 107 (84.3%) of an estimated 127 homebirths being reported to the unit.

7 The proportion of multiple births peaked at 3.6% of all births in 2002 and 2003, and in 2013 this proportion was 
3.3% of all births.

8 The induction rate increased from 22.1% in 1981 to 32.5% in 2013. Forty-five percent of inductions in 2013 were 
performed for other than defined indications.

9 The fall in the proportion of normal spontaneous vaginal births (from 66.1% in 1981 to 53.9% in 2013, breech births 
(from 1.1% to 0.5%) and forceps births (from 15.2% to 5.6%). The proportion delivered by ventouse increased from 
0.7% to 6.9% in 2010, and was 5.9% in 2013, and by caesarean section, from 16.9% in 1981 to 34% in 2013.

10 The gradual increase in the proportion of low birthweight births (&lt;2,500 grams) from 5.8% in 1981 to 7.7% in 
2013. Amongst liveborn babies, the proportion of low birthweight births was 7.1% in 2013, compared with 6.0% 
in 1991. The proportion of preterm births also increased from 5.5% in 1981 to 9.8% in 2013.

11 The proportion of births with congenital abnormalities identified before discharge from hospital after birth has 
been relatively stable at 2.3%-2.8% during the last decade and was 2.8% in 2013.

12 The increase in the proportion of babies utilising Level II care from 6.7% in 1982 to 16.5% in 2013. The 
proportion of babies utilising neonatal intensive care has decreased from 3.3% in 1981 to 2.7% in 2013, while 
the proportion using paediatric intensive care remained at 0.2%. The proportion in hospital at 28 days has been 
between 2.0% and 2.5% (2.4% in 2013).

14 The considerable fall in the perinatal mortality rate, despite the increasing proportion of preterm births. The 
perinatal mortality rate for national statistics (for babies of at least 500g birthweight or 22 weeks gestation 
if birthweight unavailable) has fallen from 11.6 in 1981 to 5.2 per 1,000 births in 2013, while the rate for 
international statistics (for births of 1,000g or 28 weeks if birthweight unavailable) has fallen from 7.2 to 2.8 per 
1,000 births during the same period. The fall in this neonatal mortality rate (for early neonatal deaths) has been 
particularly outstanding, reaching 0.5 per 1000 live births in 2013, the lowest recorded in the state being 0.4 
per1,000 births in 2012. The fall in perinatal mortality is reflected in the standardized perinatal mortality ratio 
which has been calculated in Table 48 for each year utilising perinatal mortality rates for 500g birthweight groups 
for the years 1981-1989 combined as the standard. It was 44.3 in 2013 compared with 117.6 in 1981.

Pregnancy Outcome in South Australia 2013page 76

Trends in Perinatal Statistics in South Australia, 1981-2012



Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2004   2013

Characteristic
Year

1981 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

1 Total births 19,052 17,522 18,196 18,803 19,757 19,970 19,901 20,002 20,344 20,666 20,263

2 Live births 18,905 17,409 18,067 18,663 19,624 19,819 19,761 19,883 20,194 20,528 20,125

3 Women who 
gave birth 18,857 17,229 17,897 18,519 19,471 19,672 19,604 19,667 20,043 20,338 19,925

4 Total fertility 
rate per 
woman

1.75 1.74 1.82 1.82 1.91 1.91 1.87 1.84 1.89 1.91 1.85

5 Place of birth (%)
 Teaching hospital 52.2% 49.9% 51.6% 52.1% 52.6% 53.2% 53.7% 54.3% 55.5% 56.8% 57.3%

 Private hospital 19.7% 27.2% 26.5% 26.7% 26.6% 26.5% 25.7% 25.6% 24.1% 23.3% 22.8%

 Country hospital 27.8% 22.5% 21.6% 20.8% 20.2% 20.3% 19.9% 19.3% 19.9% 19.4% 19.3%

 Domiciliary* 0.3% 0.4% 0.3% 0.5% 0.5% 0.5% 0.7% 0.7% 0.5% 0.5% 0.6%

(65) (67) (63) (87) (107) (101) (134) (144) (96) (95) (114)

6 Race (%)
 Aboriginal 1.5% 2.8% 2.7% 3.0% 3.0% 3.2% 3.1% 3.2% 3.5% 3.3% 3.6%

(Women who  
gave birth) (277) (484) (487) (548) (578) (624) (607) (625) (693) (662) (717)

(Births to 
Aboriginal 
mothers)

(280) (491) (492) (559) (590) (637) (618) (630) (703) (669) (729)

(Babies identified 
as Aboriginal) (904) (952)

 Asian 1.8% 4.8% 5.3% 5.1% 6.2% 7.0% 8.1% 9.6% 11.1% 12.1% 12.0%

7 Age

 Mean age (years) 26.55 29.81 29.86 30.01 30.05 30.11 30.14 30.14 29.69 30.21 29.8

 Teenage  (%) 7.8% 5.3% 5.2% 4.8% 4.6% 4.5% 4.1% 4.0% 4.0% 3.9% 3.3%

?35 years  (%) 4.6% 17.9% 18.7% 20.4% 20.2% 21.1% 21.1% 20.5% 20.6% 20.4% 19.8%

8 Marital status (%)
 Never married 7.6% 11.8% 12.5% 11.7% 11.0% 10.7% 10.0% 9.6% 9.2% 9.2% 8.8%

Widowed/ 
divorced/  
separated (%)

2.0% 1.3% 1.3% 1.3% 1.4% 1.2% 1.2% 1.3% 1.0% 1.3% 1.3%

(Single) (9.6%) (13.0%) (13.8%) (13.0%) (12.5%) (11.9%) (11.2%) (10.9%) (10.2%) (10.5%) (10.1%)

9 Primiparae

 Mean age (years) 24.42 28.13 28.02 28.20 28.30 28.24 28.27 28.34 27.92 28.44 28.20

 Teenage 15.4% 10.0% 10.1% 9.5% 8.9% 8.8% 8.4% 7.8% 7.8% 7.8% 6.7%

?35 years 1.2% 11.0% 11.4% 12.6% 12.5% 12.7% 12.8% 12.2% 12.0% 11.8% 12.4%

*includes unplanned home births

Pregnancy Outcome in South Australia 2013 page  77

Trends in Perinatal Statistics in South Australia, 1981-2012



Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2004   2013

Characteristic
Year

1981 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
1 Plurality

Multiple births 
(%) 2.0% 3.3% 3.3% 3.0% 2.9% 3.0% 3.0%

3.3% 2.9% 3.2% 3.3%

Twins (363) (578) (570) (552) (544) (592) (578) (644) (586) (636) (640)

Triplets (21) (6) (21) (12) (21) (3) (12) (15) (12) (15) (27)

Quadruplets (0) (0) (0) (0) (0) (0) (0) (4) (0) (0) (0)

2 Induction of 
labour (%) 22.1% 27.9% 28.3% 28.9% 29.8% 28.6% 29.4% 29.6% 31.2% 30.9% 32.5%

3 Method of birth
Normal 
spontaneous 66.1% 55.9% 55.8% 56.0% 56.0% 56.0% 55.4% 55.2% 54.7% 54.2% 53.9%

Elective caesarean 8.2% 14.0% 14.6% 15.5% 15.3% 15.4% 15.7% 15.5% 15.8% 15.9% 16.2%

Emerg caesarean 8.7% 17.6% 17.6% 17.4% 17.1% 16.8% 16.7% 16.7% 17.3% 17.9% 17.8%

Forceps 15.2% 5.0% 4.2% 3.7% 4.1% 4.2% 4.6% 5.4% 5.7% 5.5% 5.6%

Breech 1.1% 0.4% 0.4% 0.4% 0.4% 0.5% 0.4% 0.3% 0.5% 0.4% 0.5%

Ventouse 0.7% 7.1% 7.3% 7.0% 7.1% 7.1% 7.2% 6.9% 5.9% 6.0% 5.9%

Total caesarean (16.9%) (31.5%) (32.3%) (32.9%) (32.3%) (32.2%) (32.4%) (32.2%) (33.2%) (33.8%) (34.0%)

4 Birthweight 
&lt;2,500g 5.8% 7.0% 7.6% 7.0% 6.9% 7.0% 7.3% 7.2% 7.5% 7.7% 7.7%

Singletons 4.9% 5.3% 5.9% 5.5% 5.5% 5.5% 5.7% 5.6% 6.2% 6.1% 5.8%

Multiples 52.1% 55.8% 57.7% 53.4% 53.6% 53.4% 59.8% 54.1% 51.9% 56.8% 63.0%

5 Gestational age 
&lt;37 weeks 5.5% 8.7% 9.0% 8.2% 8.5% 8.6% 9.0%

8.9% 9.2% 9.4% 9.8%

Singletons 4.8% 7.0% 7.3% 6.8% 7.1% 7.0% 7.2% 7.2% 7.5% 7.6% 7.7%

Multiples 41.1% 58.4% 58.4% 54.4% 57.2% 59.3% 67.5% 58.4% 61.5% 64.7% 70.6%

6 Congenital 
abnormalities 3.4% 2.5% 2.5% 2.3% 2.6% 2.7% 2.7% 2.8% 3.0% 2.7% 2.8%

7 Level II care Na 16.6% 16.2% 15.3% 16.1% 15.4% 15.3% 16.0% 16.2% 16.7% 16.5%
8 Level III care 3.3% 2.9% 2.9% 2.5% 2.3% 2.5% 2.9% 2.5% 2.6% 2.7% 2.7%
9 W&amp;CH ICU care Na 0.2% 0.3% 0.2% 0.3% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2%

10 Hospitalisation 
for 28 days or 
more

4.2% 2.3% 2.4% 2.0% 2.1% 2.2% 2.2% 2.0% 2.2% 2.4% 2.4%

11 Neonatal deaths 96 52 63 38 55 51 49 44 44 46 45
12 Stillbirths 147 113 129 140 132 151 140 119 150 138 138
13 Perinatal deaths 243 165 192 178 188+ 202 189 163 194 184 183
14 Perinatal mortality rate per 1,000 births

?400g/20 weeks 12.8 9.4 10.6 9.5 9.5 10.1 9.5 8.1 7.4 8.9 9.0
?500g/22 weeks* 11.6 5.7 6.2 4.9 5.2 5.3 4.9 4.4 5.3 4.1 5.5
?1,000g/28 
weeks* 7.2 3.5 3.7 3.1 2.6 3.4 3.5 3.2 3.2 2.1 2.8

15 Standardized 
perinatal 
mortality ratio

117.6 66.9 66.5 63.0 65.1 67.3 65.2 57.6 52.8 42.6 44.3

* only neonatal deaths within the first 7 days of life are included, as recommended by the World Health Organisation for national and international 
statistics.

Pregnancy Outcome in South Australia 2013page 78

Trends in Perinatal Statistics in South Australia, 1981-2012



Trends in Perinatal Statistics in South Australia (SA), 1985   2013

Figure 30.1: Percentage of teenage women among women giving birth in SA

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Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA

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Figure 30.3: Percentage of primiparous women aged 35 years and over in SA

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Pregnancy Outcome in South Australia 2013 page  79

Trends in Perinatal Statistics in South Australia, 1981-2012



Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA

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Asian Aboriginal 

Figure 30.5: Percentage of women never married and with no de facto partner among women giving birth 
in SA

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Figure 30.6: Percentage of multiple births among births in SA

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Pregnancy Outcome in South Australia 2013page 80

Trends in Perinatal Statistics in South Australia, 1981-2012



Figure 30.7 Percentage of low birthweight babies among births in SA

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Figure 30.8: SA standardised perinatal mortality ratio (SPMR)

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Pregnancy Outcome in South Australia 2013 page  81

Trends in Perinatal Statistics in South Australia, 1981-2012



VII. Summary Statistics for 2013
These statistics refer to all live births as well as stillbirths of at least 400g birthweight or 20 weeks gestation. Fifty 
babies of less than 400g birthweight have been included.

1. Number of births

Reported number of births (from monthly notifications): 20,263

Notified births with Supplementary Birth Records: 20,263

Notified women who gave birth with SBRs: 19,925

Crude birth rate: 12.0 live births per 1,000 population.  

Total fertility rate: 1.85 live births per woman

2. Place of birth

Home births: 114 home births in all (0.6%), of which 107 were planned home births (0.5% of births in the state). 

Metropolitan teaching hospitals: 11,609 (57.3%)

Metropolitan private hospitals: 4,622 (22.8%)

Country hospitals: 3,918 (19.3%)

3. Sex

Males 10,531, Females 9,731. Male: Female sex ratio = 1.08:1

4. Plurality and condition at birth

Condition at birth

Plurality

TotalSingleton Twins Triplets

Live birth 19,462 636 27 20,125

Stillbirth 134 4 0 138

Total 19,596 640 27 20,263

5. Race of women

Race Number of women %

Caucasian 15,600 78.3

Aboriginal 717 3.6

Asian 2,394 12.0

Other 1,214 6.1

Total 19,925 100.0

Pregnancy Outcome in South Australia 2013page 82

Summary Statistics for 2012



6. Obstetric interventions in 19,925 women who gave birth

Induction of labour was performed for 6,476 women (32.5%) and labour was augmented for another 3,530 women 
(17.7%) who gave birth.

Forceps were utilised for 1,127 women (5.7%), ventouse in 1,127 (5.7%) and episiotomy was performed for 1,175 
women who gave birth (12.6%, or 19.1% of women who gave birth vaginally).

Caesarean section was performed in 6,778 women who gave birth (34%), of which 3,237 (16.2%) were elective, and 
3,541 (17.8%) emergency operations.

7. Low birthweight (&lt;2,500g)

Number of singleton births of low birthweight =1,132 (5.8% of singleton births).

Number of multiple births of low birthweight =420 (63% of multiple births).

Number of all births of low birthweight =1,552 (7.7% of all births).

8. Congenital anomalies

Births notified with congenital anomalies: 565 (2.8%).

9. Perinatal mortality rates (numbers of deaths in parentheses)

Birthweight/Gestation Stillbirth rate per 1,000 births
Neonatal death rate per 

1,000 live births
Perinatal mortality rate 

per 1,000 births

1 ?400g/20 weeks (138)    6.8 (45)    2.2 (183)    9.0

2 ?500g/22 weeks if birthweight 
unavailable

(WHO National Statistics*)
(80)    4.0 (23)    1.1* (103)    5.1*

3 ?1,000g/28 weeks if birthweight 
unavailable

(WHO International/ Standard 
Statistics*)

(46)    2.3 (11)    0.5* (57)     2.8*

* Only neonatal deaths within the first 7 days of life are included.

10. Terminations of pregnancy

Total number of induced abortions notified: 4,681

Induced abortion rate per 1,000 women (15-44 years): 14.4

Total induced abortion rate (life-time) per 1,000 women (15-44 years): 430.0 

Total first induced abortion rate (life-time) per 1,000 women (15-44 years): 276.1

Induced abortion proportion: 0.19

Pregnancy Outcome in South Australia 2013 page  83

Summary Statistics for 2012



References
1. Scheil W, Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth 

Record. Adelaide: Pregnancy Outcome Unit , South Australian Department of Health, 2012.

2. The South Australian Birth Defects Register. 2008/2009 Annual Report. Adelaide: Women s and Children s 
Hospital, Children, Youth and Women s Health Service, 2015.

3. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia 
2013. Adelaide: SA Health, Government of South Australia, 2015.

4. Statewide Service Strategy Division. Standards for Maternal and Neonatal Services in SA 2010. Adelaide: 
Department of Health, 2010.

5. South Australian Health Commission. Report of the South Australian Birthing Services Working Group. Adelaide: 
Social Health and Policy Development Branch, South Australian Health Commission, 1994.

6. South Australian Abortion Reporting Committee. Eleventh Annual Report - For the Year 2013. Adelaide:  SA 
Health, Government of South Australia, 2015.

7. South Australian Health Commission Epidemiology Branch. Risk factors for adverse perinatal outcome: 
determination from a perinatal statistics collection. Adelaide: South Australian Health Commission, December 
1986.

8. Mallett R, Knox EG. Standardized perinatal mortality ratios: technique, utility and interpretation. Community 
Med 1979; 1: 6-13.

9. AHMC (Australian Health Ministers  Conference) 2011. National Maternity Services Plan. Canberra: Australian 
Government Department of Health and Ageing.

10. AIHW National Perinatal Epidemiology and Statistics Unit and AIHW 2013. National core maternity indicators. 
Cat. no. PER 58. Canberra: AIHW.

Pregnancy Outcome in South Australia 2013page 84

References



Publications
The following is a list of publications from 1985 from the Pregnancy Outcome Unit or which utilised data from the Unit.

Annual Reports
1. Pregnancy Outcome in South Australia (from 1985), website: www.sahealth.sa.gov.au

2. Maternal, Perinatal and Infant Mortality in South Australia. Annual Report of the Maternal, Perinatal &amp; Infant 
Mortality Committee (from 1985), website: www.sahealth.sa.gov.au

3. Committee appointed to examine and report on abortions notified in South Australia Annual Report  (from 1985 
to 2002). South Australian Abortion Reporting Committee Annual Report (from 2003).

4. Pregnancy and Neonatal Care Bulletin (from 1985): for individual hospitals.

The Unit provides birth defects data to the South Australian Birth Defects Register at the Women s and Children s 
Hospital and perinatal and birth defects data to the Australian Institute of Health and Welfare National Perinatal 
Statistics Unit in Sydney for their reports.

These reports are as follows:

1. The South Australian Birth Defects Register Annual Report (from 1986).

2. Congenital anomalies in Australia (from 1981) 

 South Australian Birth Defects Register, Public Health Research Unit, Women s and Children s Hospital, 
Children, Youth and Women s Health  Service, 72 King William Road, North Adelaide, South Australia 5006. 
Telephone (08) 8161 6518 
Website: www.sahealth.sa.gov.au/pregnancyoutcomes

3. Australia s Mothers and Babies (from 1991)

 AIHW National Perinatal Statistics Unit, Sydney Children s Hospital, Level 2, McNevin Dickson Building, 
Randwick Hospital Campus, Randwick NSW 2031. 
Telephone (02) 9382 1014  
Website: www.npsu.unsw.edu.au 

Other reports/papers
1. Birth defects

1. Jonas O, Stern LM, Macharper T. A South Australian Study of Pregnancy and Birth Risk Factors associated 
with Cerebral Palsy. Int J Rehab Research 1989; 12 (2): 159-166.

2. Chan A, Robertson EF, Haan EA, Keane RJ, Ranieri E, Carney A. Prevalence of neural tube defects in South 
Australia, 1966   91: effectiveness and impact of prenatal diagnosis. BMJ 1993; 307: 703-6.

3. Bower C, Norwood F, Knowles S, Chambers H, Haan E, Chan A. Amniotic band syndrome: a population-
based study in two Australian States. Paediatr Perinat Epidemiol 1993; 7: 395-403.

4. Chan A, Robertson E, Haan E, Ranieri E, Keane R. The sensitivity of ultrasound and serum alpha-fetoprotein 
in population-based antenatal screening for neural tube defects in South Australia 1986-1991. Br J Obstet 
Gynaecol 1995; 102 :370-376.

5. Chan A, Keane RJ, Hanna M, Abbott M. Terminations of pregnancy for exposure to oral retinoids in South 
Australia, 1985-1993. Aust NZ J Obstet Gynaecol. 1995; 35 : 422-426.

6. Byron-Scott R, Chan A, Haan EA, Bower C, Scott H, Clark K. A population-based study of abdominal wall 
defects in South Australia and Western Australia. Proceedings, 14th Annual  Congress Australian Perinatal 
Society, Adelaide, March 1996, P82.

7. Chan A, Hanna M, Abbott M, Keane RJ. Oral retinoids and pregnancy. MJA 1996;165: 164-167.

8. Chan A, McCaul KA, Cundy P, Haan EA, Byron-Scott R. Perinatal risk factors for developmental dysplasia of 
the hip. Arch Dis Child 1997; 76 : F94   F100.

Pregnancy Outcome in South Australia 2013 page  85

Publications



9. Yiv BC, Saidin R, Cundy PJ, Tgetgel JD, Aguilar J, McCaul KA, Keane RJ, Chan A, Scott H. Developmental 
dysplasia of the hip in South Australia in 1991: Prevalence and risk factors. J. Paediatr Child Health 1997; 
33: 151-6.

10. Cheffins T, Chan A, Keane RJ. The effects of rubella immunisation in South Australia. Proceedings, Rights to 
Health 29th Annual Conference, Public Health Association of Australia Inc., Melbourne, 5-8 October 1997.

11. Byron-Scott R, Haan E, Chan A, Bower C, Scott H, Clark K. A population-based study of abdominal wall 
defects in South Australia and Western Australia. Paediatr Perinat Epidemiol. 1998; 12: 136-151.

12. Cheffins T,  Chan A, Keane RJ, Hann EA, Hall R. The impact of rubella immunisation on the incidence of 
rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia. Br J 
Obstet Gynaecol 1998; 105: 998-1004.

13. Chan A, McCaul K, Keane RJ, Haan EA. Effect of parity, gravidity, previous miscarriage, and age on the risk 
of Down s syndrome : population-based study. BMJ 1998; 317: 923-4.

14. Byron-Scott R. et al. A validation study of congenital heart defects in South Australia. Proceedings, 
Australian Birth Defects Society. Annual Scientific Meeting. Sydney 1998.

15. Byron-Scott R. et al. A comparison of selected birth defects in Aboriginal and non-Aboriginal babies in 
South Australia. Proceedings, Australian Birth Defects Society. Annual Scientific Meeting, Sydney 1998.

16. Byron-Scott R. Richardson M, Hiller J, Chan A, Haan E, Knight B, Adams P. The prevalence and validation 
of congenital heart defects in South Australia, 1986-94. Proceedings of the 3rd Annual Congress of the 
Perinatal Society of Australia and New Zealand, Melbourne, 1999. P153.

17. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Late diagnosis of congenital dislocation of the hip and 
presence of a screening programme. South Australian population-based study. Lancet 1999;354:1514-17.

18. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Screening for congenital dislocation of the hip 
(letter). Lancet 2000;355:232-33.

19. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ.  Folate before pregnancy : the 
impact of a South Australian health promotion campaign on women and health professionals. Western 
Australian Birth Defects Registry Twentieth Anniversary Scientific Symposium April 27-28, 2000. Perth, 
Western Australia. Teratology 2000;62: 365.

20. Cheffins T, Chan A, Haan EA, Ranieri E, Ryall RG, Keane RJ, Byron-Scott R, Scott H, Gjerde EM, Nguyen 
A-M, Ford JH, Sykes S. The impact of maternal serum screening on the birth  revalence of Down s syndrome 
and the use of amniocentesis and chorionic villus sampling in South Australia. Br J Obstet Gynaecol 
2000;107:1453-9.

21. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ.  Folate before pregnancy :the 
impact on women and health professionals of a population-based health promotion campaign in South 
Australia. MJA 2001; 174:631-636.

22. Chan A, Foster BK, Cundy PJ. Invited commentary. Problems in the diagnosis of neonatal hip instablity. Acta 
Paediatr 2001;90:836-9.

23. Metz MP, Ranieri E, Gerace RL, Priest KR, Luke CG, Chan A. Newborn screening in South Australia: is it 
universal? MJA 2003;179:412-415.

24. Chan A. Invited commentary: Parity and the risk of Down syndrome   caution in interpretation. Am J 
Epidemiol 2003;158:509-511.

25. Gibson CS, MacLennan AH, Hague WM, Rudzki Z, Sharpe P, Chan A, Dekker GA. Fetal thrombophilic 
polymorphisms are not a risk factor for cerebral palsy. Perinatal Society of Australia and New Zealand 8th 
Annual Congress, Convention Centre, Darling Harbour, Sydney, Australia, 15th-18th March 2004, A41.

26. Gibson CS, MacLennan AH, Rudzki Z, Hague WM, Haan EA, Sharpe P, Priest K, Chan A, Dekker GA for the 
South Australian Cerebral Palsy Research Group. The prevalence of inherited thrombophilias in a Caucasian 
Australian population. Pathology  2005;37:160-163.

Pregnancy Outcome in South Australia 2013page 86

Publications



27. Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A, Scott H, Baghurst PB, Haan E. A South Australian 
population-based study of congenital talipes equivarus. Paediatr Perinat Epidemiol  2005;19:227-237.

28. Gibson CS, MacLennan AH, Hague WM, Haan E, Priest K, Chan A, Dekker GA  for the South Australian 
Cerebral Palsy Research Group. Associations between inherited thrombophilias, gestational age and 
cerebral palsy. Am J Obstet Gynecol 2005;193:1437.e1-1437.e12.

29. Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986-
2000: a population-based cohort study. Birth Defects Research Part A  Clin Mol Teratol 2005:73;605-611.

30. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral 
Palsy Research Group. Neurotropic viruses and cerebral palsy: a population bases case-control study. BMJ 
,doi:10.1136/bmj.38668.616806.3A (published 6 January 2006).

31. Sharpe PB, Mulpuri K, Chan A, Cundy P. Differences in risk factors between early and late diagnosed DDH. 
Arch Dis Child 2006;91:F158-162.

32. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral 
Palsy Research Group. The association between inherited cytokine polymorphisms and cerebral palsy. Am J 
Obstet Gynecol 2006;194: 674.e1-674.e11.

33. Gibson CS, MacLennan AH, Janssen NG, Kist WJ, Hague WM, Haan EA, Goldwater PN, Priest K, Dekker GA 
for the South Australian Cerebral Palsy Research Group. Associations between fetal inherited thrombophilia 
and adverse pregnancy outcomes. Am J Obstet Gynecol  2006; 194: 947.e1-947.e10.

34. Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ, Tsang S,  Stewart C, 
Nelson KB. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol 2007;109:384-391.

35. Muller PR, Cocciolone R, Haan EA, Wilkinson C, Scott H, Sage L, Bird R, Hutchinson R, Chan A. Trends in 
state/population-based Down syndrome screening and invasive prenatal testing with the introduction of 
first-trimester combined Down syndrome screening, South Australia, 1995-2005. Am J Obstet Gynecol 
2007;196:315.e1-315.e7.

36. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral 
Palsy Research Group. Mannose-binding lectin haplotypes may be associated with cerebral palsy only after 
perinatal viral exposure. Am J Obstet Gynecol 2008;198:509.e1-509.e8.

37. Khoo NS, van Essen P, Richardson M, Robertson T. Effectiveness of prenatal diagnosis of congenital heart 
defects in South Australia: a population analysis 1999-2003. Aust NZ J Obstet Gynaecol 2008;48:559-563.

38. Chan AC, van Essen P, Scott H, Haan EA, Sage L, Scott J, Gill TK, Nguyen A-M T. Folate awareness and the 
prevalence of neural tube defects in South Australia, 1966-2007. MJA 2008;189: 566-569.

39. Djukic M, Gibson CS, MacLennan AH, Goldwater PN, Haan EA, McMichael G et al. Genetic susceptibility to 
viral exposure may increase the risk of cerebral palsy. Aust NZ J Obstet Gynaecol 2009: 49:247-253.

40. De Souza, Halliday J, Chan A, Bower C, Morris JK. Recurrence risks for trisomies 13,18, and 21. Am J Med 
Genet Part A 149A:2716 2722.

41. Davies MJ, Moore VM, Willson KJ, Van Essen P, Priest K, Scott H, et al. Reproductive technologies and the 
risk of birth defects. N Engl J Med. 2012 May 10;366(19):1803-13. PubMed PMID: 22559061.

42. Flood L, Scheil W, Nguyen A, Sage L, Scott J. An increase in neural tube defect notifications, South 
Australia, 2009 2010. Western Pacific Surveillance and Response Journal, 2013, 4 (2). doi:10.5365/
wpsar.2012.3.3.006 

Pregnancy Outcome in South Australia 2013 page  87

Publications



2. Termination of pregnancy

1. Hart G, Macharper T. Medical termination of pregnancy in South Australia 1970-1984. Adelaide: South 
Australian Health Commission, 1986.

2. Chan A, Taylor A. Medical Termination of Pregnancy in South Australia - The First 20 Years 1970-1989. 
Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, December 1991.

3. Chan A, McColl M, Versteeg J, Gameau B, Scanlan C, Pridmore B. A South Australian Study on 
Contraception and Abortion. Public and Environmental Health Service, South Australian Health Commission 
and Department of Obstetrics and Gynaecology, The Queen Elizabeth Hospital, Adelaide, March 1994.

4. Hart G, Macharper T. Clinical aspects of induced abortion in South Australia from 1970-1984. Aust. NZ J 
Obstet Gynaecol 1986; 26: 219-224.

5. Hart G, Macharper T. Induced abortion trends in South Australia. Am J Public Health 1987; 77: 200-202.

6. Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. Am J Epidemiol 
2004;159:475-480.

7. Chan A, Sage LC. Estimating Australia s abortion rates 1985-2003. MJA  2005;182:447-452.

3. Perinatal epidemiology

1. Connon AF, Macharper T. Teenage pregnancies in South Australia. Adelaide: South Australian Health 
Commission, September 1986.

2. South Australian Health Commission, Epidemiology Branch:  Characteristics of pregnancies and births 
among migrant women in South Australia. Adelaide : South Australian Health Commission, October 1986.

3. South Australian Health Commission, Epidemiology Branch. Risk factors for adverse perinatal outcome: 
determination from a perinatal statistics collection. Adelaide: South Australian Health Commission, 
December 1986.

4. South Australian Health Commission, Epidemiology Branch. Variation in perinatal risk by place of residence 
of mother in South Australia. Adelaide: South Australian Health Commission, December 1986.

5. South Australian Health Commission, Epidemiology Branch. Variations in Perinatal Risk by Hospital of Birth 
in South Australia. Adelaide: South Australian Health Commission, January 1987.

6. South Australian Health Commission, Epidemiology Branch. Aboriginal Births in South Australia, 1981-
1986: An Analysis of Perinatal Outcomes, Adelaide: South Australian Health Commission, May 1988.

7. South Australian Health Commission, Epidemiology Branch: Pregnancy Outcome Attributes by Postcode: 
South Australia 1981-1986. South Australian Health Commission, Adelaide: August 1988.

8. Jonas O, Scott J, Chan A, Macharper T, Lister J. A validation study of the 1986 perinatal data collection 
form. Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, 1991.

9. South Australian Cancer Registry. Associations between perinatal characteristics and risk of childhood 
cancer: South Australian cancer cases born in 1981-1993. In: Epidemiology of Cancer in South Australia. 
Incidence, Mortality and Survival 1977 to 1994. Adelaide South Australian Health Commission, 1995.

10. Taylor A, Twisk A-M, Chan A. Perinatal risk factors by postcode in South Australia 1989-1992. Epidemiology 
Branch, South Australian Health Commission, Adelaide: June 1995.

11. Pregnancy Outcome Unit. Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record. 
Adelaide: South Australian Health Commission, December 1997.

12. McLean A, Scott J, Keane RJ, Sage L, Chan A. Validation of the 1994 South Australian perinatal data 
collection form. Adelaide: Pregnancy Outcome Unit, Department of Human Services, 2001.

13. Hart G, MacHarper T, Moore D, Roder D. Aboriginal pregnancies and births in South Australia. MJA 1985; 
143: S54-56.

14. Chan A, Roder D, Macharper, T. Obstetric Profiles of Immigrant Women from Non-English Speaking 
Countries in South Australia, 1981-83. Aust NZ J Obstet Gynaecol 1988; 28: 90-95.

Pregnancy Outcome in South Australia 2013page 88

Publications



15. Jonas O, Roder D, Esterman A, Macharper T, Chan A. Pregnancy and Birth Risk Factors for Intellectual 
Disability in South Australia. Eur J Epidemiol 1989; 5: 322-327.

16. Jonas O, Chan A, Macharper T, Roder D. Pregnancy and Perinatal Factors associated with persistently low 
Apgar scores: an analysis of the birth records of infants born in South Australia. Eur J Epidemiol 1990; 6: 
136-141.

17. Crotty M, Ramsay AT, Smart R, Chan A. Planned Homebirths in South Australia 1976-1987 MJA 1990; 153: 
664-671.

18. Jonas O, Chan A, Roder D, Macharper T. Pregnancy Outcomes in primigravid women aged 35 years and 
over in South Australia, 1986-1988.  MJA 1991; 154: 246-249.

19. Zhang B, Chan A. Teenage Pregnancy in South Australia, 1986-1988. Aust. NZ J Obstet Gynaecol 1991; 31: 
291-298.

20. Jonas O, Roder D, Chan A. The Association of Maternal and Socioeconomic Characteristics in Metropolitan 
Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes. Aust NZ J Obstet 
Gynaecol 1992; 32: 1-5.

21. Chan A, Roder D, Priest K, Esterman A. A perinatal perspective on South Australia in the 1980s. MJA 1992; 
157: 515-518.

22. Jonas O, Roder D, Chan A. The association of low socio-economic status in Metropolitan Adelaide with 
maternal demographic and obstetric characteristics and pregnancy outcome. Eur J Epidemiol 1992; 8:708.

23. Jonas O, Roder D. Breech Presentation in South Australia, 1987-1989. Aust NZ J Obstet Gynaecol 1993; 33: 
17-21.

24. Scott J, Chan A. Planned birthing unit deliveries in South Australia. Proceedings, 14th Annual Congress 
Australian Perinatal Society, Adelaide, March 1996, P21.

25. Dal Grande E, Chan A, Keane R. Asian, but different: Obstetric characteristics of women born in Vietnam 
and Philippines who delivered in South Australia in 1991-1994. Proceedings, 14th Annual Congress 
Australian Perinatal Society, Adelaide, March 1996, P22.

26. Keane R, Dal Grande E, Chan A, McCaul K. Episiotomy   a decline in the cutting edge. Proceedings, 14th 
Annual Congress Australian Perinatal Society, Adelaide, March 1996, P75.

27. Chan A, McPhee AJ. A safer leap into this dangerous world. Lancet 1996; 348 (suppl II) :12.

28. Carter JR, Hiller JE, Ryan P, Chan A. The Association between maternal age and preterm births to 
primiparous women in South Australia, 1991-1993, Proceedings, First Annual Congress, Perinatal Society of 
Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.

29. Zhang B, Hiller JE, Chan A. Asthma in pregnancy in South Australia. Proceedings, First Annual Congress, 
Perinatal Society of Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.

30. Roder D, Nguyen A-M, Chan A. Trends in perinatal characteristics in South Australia, 1981 to 1994, by 
place of residence of mother. Aust NZ J Public Health 1997; 21: 483-8.

31. Zhang B, Hiller JE, Chan A. Asthma in pregnancy: Association with Spontaneous Preterm Birth. Proceedings 
of the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, Melbourne, 1999, A113.

32. McLean AP, Hiller JE, Chan A. Maternal epilepsy and fetal outcomes in South Australia. Perinatal Society 
of Australia and New Zealand 4th Annual Congress. Brisbane Convention and Exhibition Centre, Brisbane, 
Australia, 12-15 March 2000, P192.

33. Chan A, Keane RJ, Robinson JS. The contribution of maternal smoking to preterm birth, small for 
gestational age and low birthweight among Aboriginal and non-Aboriginal births in South Australia. MJA 
2001;174: 389-93.

34. van der Klis KAM, Westenberg L, Chan A, Dekker G, Keane RJ. Teenage pregnancy: trends,characteristics 
and outcomes in South Australia and Australia. Aust N Z J Public Health 2002; 26: 125-31.

35. Westenberg L, van der Klis KAM, Chan A, Dekker G, Keane RJ. Aboriginal teenage pregnancies compared 
with non-Aboriginal in South Australia 1995-1999. Aust N Z J Obstet Gynaecol 2002;42: 187-191.

36. Wang JX, Knottnerus A-M, Schuit G, Norman RJ, Chan A, Dekker GA. Surgically obtained sperm and risk of 
gestational hypertension and pre-eclampsia. Lancet 2002;359: 673-4.

Pregnancy Outcome in South Australia 2013 page  89

Publications



37. Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for hypertension during 
pregnancy in South Australia. Aust NZ J Obstet Gynaecol 2003; 3: 421-428.

38. Heard AR, Dekker GA, Chan A, Jacobs DJ, Vreeburg SA, Priest KR. Hypertension during pregnancy in South 
Australia, Part 1: Pregnancy outcomes. Aust NZ J Obstet Gynaecol 2004; 44: 404-409.

39. Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South 
Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome   results of multivariable 
analysis. Aust NZ J Obstet Gynaecol 2004;44: 410-418.

40. Leahy K, Elliot E, Kennare R, Chan A. Characteristics and pregnancy outcomes of first time mothers aged 
35 years and over compared to younger first time mothers in South Australia 1991-2002. Before and 
Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress. Adelaide 
Convention Centre, Adelaide, South Australia, 13-16 March 2005, A144.

41. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal 
outcomes in South Australia. Aust NZ J Obstet Gynaecol  2005;45:220-225.

42. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of spontaneous preterm birth. Perinatal 
Society of Australia and New Zealand 10th Annual Congress. Perth Convention Exhibition Centre, Perth, 
Western Australia, 3-6 April 2006, FC17.1, p 165.

43. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth 
Record. Adelaide: Pregnancy Outcome Statistics Unit, South Australian Department of Health, 2006.

44. Budde MP, De Lange TE, Dekker GA, Chan  A, Nguyen AM. Risk factors for placental abruption in a socio-
economically disadvantaged region. J Matern Fetal Neonat Med 2007 Sep; 20(9):687-93. 

45. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of pre-term birth: a population study. J 
Matern-Fetal Neonat Med 2009;22(1):1-7.

46. Kennare R, Keirse M, Tucker G, Chan A. Planned home and hospital births in South Australia, 1991 2006: 
differences in outcomes. MJA 2010; 192: 76 80.

47. Dodd J, Grivell R, Nguyen AM, Chan A, Robinson J. Maternal and perinatal health outcomes by body mass 
index category. ANZJOG 2011: 51,2: 136 140.

48. Grivell RM, Reilly AJ, Oakey H, Chan AC, Dodd JM. Maternal and neonatal outcomes following induction of 
labor: a cohort study. Acta Obstet Gynecol Scand 2012; 91:198 203.

49. Ludford I, Scheil W, Tucker G, Grivell R. Pregnancy outcomes for nulliparous women of advanced maternal 
age in South Australia, 1998-2008. The Australian &amp; New Zealand Journal of Obstetrics &amp; Gynaecology. 
2012 Jun;52(3):235-41. PubMed PMID: 22553967.

50. Dodd JM, Catcheside B, Scheil W. Can shoulder dystocia be reliably predicted? The Australian &amp; New 
Zealand Journal of Obstetrics &amp; Gynaecology. 2012 Jun;52(3):248-52. PubMed PMID: 22428758.

51. Hodyl NA, Stark MJ, Scheil W, Clifton VL. Maternal asthma is a significant contributor to neonatal morbidity. 
Journal of Developmental Origins of Health and Disease 01/2011; 2:S120-S121. 

52. Hodyl NA, Stark MJ, Scheil W, Grzeskowiak LE, Clifton VL. Perinatal outcomes following maternal asthma 
and cigarette smoking during pregnancy. European Respiratory Journal: 2013 erj00549-02013.

53. Baghurst, P, Robson, S, Antoniou, G, Scheil, W and Bryce, R.  The association between increasing maternal 
age at first birth and decreased rates of spontaneous vaginal birth in South Australia from 1991 to 2009. 
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2014; 54:237 243. doi:10.1111/
ajo.12182.

54. Baghurst P. The case for retaining severe perineal tears as an indicator of the quality for obstetric care. 
ANZJOG 2013; 53(1): 3-8.

55. Hodyl NA, Grzeskowiak LE,Stark MJ, Scheil W, Clifton VL. The impact of Aboriginal status, cigarette 
smoking and smoking cessation on perinatal outcomes in South Australia. MJA 2015; 201(5): 274-278.

56. Smithers LG, Searle AK, Chittleborough CR, Scheil W, Brinkman SA, Lynch JW. A whole-of-population 
study of term and post-term gestational age at birth and children s development. BJOG 2015; DOI: 
10.1111/1471-0528.13324.

Pregnancy Outcome in South Australia 2013page 90

Publications




4. Perinatal mortality

1. Roder D, Chan A, Esterman A. Birthweight   specific trends in perinatal mortality by hospital category in 
South Australia, 1985   1990. MJA 1993; 158: 664-667.

2. Connon AF, Chan A on behalf of the Postneonatal Subcommittee, maternal, perinatal and Inmfant 
Mortality Committee. Accidental deaths of babies in the postneonatal period in South Australia (letter). 
MJA 1994;161:397. 

3. Roder D, Chan A, Priest K. Perinatal mortality trends among South Australian Aboriginal births 1981-92. J 
Paediatr Child Health 1995; 31: 446-450.

4. Haslam R, McPhee A, Chan A, Keane R. Neonatal mortality   a system of classification and trends in South 
Australia. Proceedings of the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, 
Melbourne, 1999. P86.

5. Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an unexplained stillbirth: 
preliminary population-based retrospective cohort study. Aust NZ J Obstet Gynaecol 2001;41: 29-35.

6. Flenady V, Chan A, Haslam R, King J, Tudehope D, McCowan L. Cause specific perinatal mortality in 
Australia and New Zealand using a new clinical classification system (ANZACPM and ANZNDC). Perinatal 
Society of Australia and New Zealand 7th Annual Congress, Hotel Grand Chancellor, Hobart, Tasmania, 
March 9th-12th 2003, A87.

7. Dodd JM, Robinson JS, Crowther CA, Chan A. Stillbirth and neonatal outcomes in South Australia, 1991-
2000. Am J Obstet Gynecol 2003;189: 1731-1736.

8. Chan A, King JF, Flenady V, Haslam RH, Tudehope DI. Classification of perinatal deaths: Development of the 
Australian and New Zealand classifications. J Paediatr Child Health 2004;40: 340-347.

9. Flenady V, King J, Chan A, McCowan L, Tudehope D, Haslam R, Charles A, Roberts C for the Perinatal 
Mortality Audit Guidelines Working Party of the PSANZ Perinatal Mortality Special Interest Group. 
Development of Clinical Practice Guideline for Perinatal Mortality Audit incorporating psychological and 
social aspects of perinatal bereavement. Before and Beyond Birth. Abstract Book. Perinatal Society of 
Australia and New Zealand 9th Annual Congress, Adelaide Convention Centre, Adelaide, South Australia, 
13-16 March 2005, P58.

10. De Lange TE, Budde MP, Heard AR, Tucker G, Kennare R, Dekker GA. Avoidable risk factors in perinatal 
deaths: a perinatal audit in South Australia. Aust NZ J Obs Gynaecol 2008;48:50-57.

11. Kennare R, Scheil W, Tucker G. A public health approach to review of sudden unexpected infant deaths   
challenges and interventions. Australian Journal of Child and Family Health Nursing 2015; 12: 1.

5. Caesarean section

1. Jonas O, Chan A, Macharper T. Caesarean Section in South Australia, 1986. Aust NZ J Obstet Gynaecol 
1989; 29: 99-106.

2. Chan A. Epidemiology of the rising Caesarean section rate. Proceedings, 14th Annual Congress Australian 
Perinatal Society, Adelaide, March 1996, A70.

3. Chan A, Keane RJ, Scott J. Elective Caesarean section and child deprivation (letter). Lancet 1996; 347: 
1196.

4. Kennare, R. Why is the caesarean section rate rising? MIDIRS Midwifery Digest 2003; 13 (4): 503-508.

5. Kennare R, Heard A, Chan A. Is caesarean section in the first birth a problem for women in the next 
birth? Before and Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual 
Congress. Ade;laide Convention Centre, Adelaide, South Australia, March 13-16 2005, A 127. 

6. Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after caesarean delivery. 
Obstet Gynecol 2007;109:270-276.

7. Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, O Neill M, Snell M, Cull V, Cornes S. 
Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a 
retrospective population-based cohort study. BJOG 2010;117:1358 1365.

Pregnancy Outcome in South Australia 2013 page  91

Publications



Appendix 1: Definitions

Abortion rate:

 =                                                                                                             x 1,000
Estimated resident population of same group in the same year

Number of induced abortions in a group of women in a year  

The abortion rate per 1,000 women in the reproductive age group 15-44 years has been calculated in this report 
using as the numerator all abortions; the denominator used has been the estimated resident population for women 
aged 15-44 years in that year.

Abortion proportion:

Abortions + live births

Abortions
 =   

This is often called the abortion ratio, which is strictly: 
Live births

Abortion

Apgar score: A numerical scoring system applied after birth (usually at 1 minute and again at 5 minutes) to evaluate 
the condition of the baby, as specified below:

Sign
Score

0 1 2

Heart rate Absent Slow (below 100) Over 100

Respiratory effort Absent Slow, irregular Good, crying

Muscle tone Flaccid Some flexion of extremities Active motion

Reflex irritability No response Grimace Vigorous cry

Colour Blue, pale Body pink, extremities blue Completely pink

Birthweight: The first weight of a fetus or newborn obtained after birth.  This is preferably measured within the first 
hour of life before significant post-natal weight loss has occurred.

Low birthweight:  Birthweight of less than 2,500g.
Very low birthweight:  Birthweight of less than 1,500g.

Body Mass Index (BMI):  weight (in kg)   height2 (in metres).
This is used as a standard for recording obesity statistics and also as a measure of underweight. However the 
categories do not take into account factors such as frame size, muscularity, varying proportions of components such 
as fat, bone, cartilage and water, and may be misleading in athletes, children and some ethnic groups. The categories 
for describing weight using BMI are:

BMI category Name
&lt;18.5 Underweight
18.5  to &lt; 25 Normal
25 to &lt; 30 Overweight
30 to &lt; 35 Obese
35 to &lt; 40 Severely obese
40 or greater Morbidly obese

Pregnancy Outcome in South Australia 2013page 92

Appendix



Caesarean section: Birth of a child by an abdominal operation.
Elective caesarean section:  One which takes place as a planned procedure before the spontaneous onset 
of labour.
Emergency caesarean section:  One which is undertaken for a complication:

(a) before the onset of labour or
(b) during labour, whether that labour is of spontaneous onset or following induction of labour.

Fertility rates:

Age-specific fertility rate:

Estimated resident population of women of that age group in the same year

Number of live births to women in an age group in a year
x 1,000

General fertility rate:

Estimated resident population of womens aged 15 - 44  years in the same year

Total number of live births in a year
x 1,000

Total fertility rate (TFR): The sum of age-specific fertility rates (live births at each age of women per female 
population of that age). It represents the number of children a woman would bear during her lifetime if she 
experienced current age-specific fertility rates at each age of her reproductive life. 

Gestational age:  The duration of pregnancy in completed weeks determined by the best obstetric estimate, using 
ultrasonography and the first day of the last normal menstrual period.

Induction of labour:  An intervention undertaken to stimulate the onset of labour by pharmacological or other 
means.

Live birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the 
duration of pregnancy, which after such separation breathes or shows any other evidence of life, such as beating of 
the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical 
cord has been cut or the placenta is attached.

Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, 
irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy 
or its management  but not from accidental or incidental causes.1

Maternal deaths are divided into two groups:

1. Direct obstetric deaths: those resulting from obstetric complications of the pregnant state (pregnancy, labour and 
puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

2. Indirect obstetric deaths: those resulting from previous existing disease or disease that developed during pregnancy 
and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.

As an extension of the WHO definition, accidental and incidental deaths occurring in pregnant women are also 
reviewed by the Maternal, Perinatal and Infant Mortality Committee so as to avoid missing indirect deaths which may 
be difficult to distinguish from incidental deaths. Examples of incidental deaths are deaths from drowning and road 
accidents, where the pregnancy is unlikely to have contributed significantly to the death, although it may be possible 
to postulate a remote association.

Multigravida: A woman who has been pregnant more than once.

Parity:  The total number of previous pregnancies resulting in live births or stillbirths.

1 World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Volume 2. Geneva: WHO, 
1993, p 134.

Pregnancy Outcome in South Australia 2013 page  93

Appendix



Perinatal deaths:
Early fetal death: Death in a fetus of less than 400g birthweight, and of less than 20 weeks gestation. A 
miscarriage is a spontaneous early fetal death.

Fetal death: Death prior to the complete expulsion or extraction from a woman of a product of conception, 
irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the 
fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the 
umbilical cord, or definite movement of voluntary muscles.

Late fetal death or stillbirth: Death in a fetus of at least 400g birthweight, or of at least 20 weeks gestation.

Late fetal death rate or stillbirth rate:

=                                                                                           x 1,000
Number of live births and still births in that year

Number of late fetal deaths or stillbirths in any year

Neonatal death: Death of a liveborn infant within 28 days of birth.

Neonatal death rate:

 =                                                                     x 1,000
Number of live births in that year

Number of neonatal deaths in any year

Perinatal death:  Includes late fetal death (stillbirth) and neonatal death.

Perinatal mortality rate (PMR):

=                                                                           x 1,000
Number of stillbirths and live births

Number of stillbirths and neonatal deaths

For South Australian statistics, the rate refers to live births and stillbirths of at least 400g birthweight or 20 
weeks gestation.

For national statistics, the rate refers to all births of at least 20 weeks gestation or 400g birthweight, and 
neonatal deaths occurring within 28 days of birth.

For international comparison, the rate refers to all births of at least 1,000g birthweight or, when birthweight 
is unavailable, of at least 28 weeks gestation and neonatal deaths occurring within seven days of birth (as 
recommended by WHO).

Preterm: less than 37+0 completed weeks gestation.

Primigravida: A woman pregnant for the first time.

Primipara: A pregnant woman who has had no previous pregnancy resulting in a live birth or stillbirth.

Race
1.  Caucasian: individuals of European descent.
2.  Aboriginal: this includes part-Aboriginals as well as full blood Aboriginals.  An Aboriginal is a person of 

Aboriginal descent who identifies as an Aboriginal and is accepted as such by the community in which he 
or she lives.

3.  Asian: (exclude Asia Minor) - In this category, include women originating from all Asian countries, 
including the Indian subcontinent (India, Bangladesh, Pakistan, Nepal, Sri Lanka), who were formerly 
listed as  Other  race.

4.  Torres Strait Islander (TSI): A Torres Strait Islander is a person of Torres Strait Islander descent who 
identifies as a Torres Strait Islander and is accepted as such by the community in which he or she lives.

5.  Aboriginal &amp; TSI: persons of both Aboriginal and Torres Strait Islander descent. 
6.  Other:  Races other than (1) - (5).  Include women from the Middle East and Africa.

Pregnancy Outcome in South Australia 2013page 94

Appendix



Guidelines for use regarding Indigenous Status - categories (2), (4) and (5).

There are three components to the definition:
 &gt; descent

 &gt; self identification

 &gt; community acceptance

It is not possible to collect the three components of the definition in a single question. The Australian Bureau 
of Statistics (ABS) proposes that the focus of a single question should be the descent, the first component 
of the definition. The ABS therefore proposes the use of the following alternative questions, depending on 
whether the person is present or not.

Where the person is present :  Are you of Aboriginal or Torres Strait Islander origin? ;

OR

where the person is not present and someone who knows the person well responds for him/her:  Is the 
person of Aboriginal or Torres Strait Islander origin? 

If the response is  Yes , then clarify whether the person is of Aboriginal origin (2), Torres Strait Islander 
origin (4) or both Aboriginal and Torres Strait Islander origin (5).

Self reporting of descent is not equivalent to self reporting of identity but because of the absence of a 
second  identity  question some respondents will interpret the  origin  question to mean both descent and 
identification. What identification in the context of the variable Indigenous Status should measure is an 
individual s self assessed historical and cultural affiliation.

Termination of pregnancy:  (synonym   induced abortion) The removal or expulsion of a pregnancy from the uterus 
via surgical or medical intervention,  performed by a medical practitioner in a prescribed hospital in South Australia, 
on specified grounds under the Criminal Law Consolidation Act and notified under the Criminal Law Consolidation 
(Medical Termination of Pregnancy) Regulations 1996. Terminations of pregnancy at gestations of 20 weeks or later or 
where the fetus weighs at least 400g, performed by induction of labour resulting in a birth  are included in the South 
Australian perinatal data collection. These are usually for congenital abnormalities or medical reasons.

Total abortion rate = the sum of the five-year age-specific induced abortion rates multiplied by 5.  

This represents the number of induced abortions 1,000 women would have during their lifetime if they experienced 
the rates of the year shown.

Pregnancy Outcome in South Australia 2013 page  95

Appendix



Appendix 2: 2013 Supplementary Birth Record Form

Appendix

Pregnancy Outcome in South Australia 2013page 96



Appendix 3: Congenital Abnormality Form

Appendix

Pregnancy Outcome in South Australia 2013 page  97



For more information 

Pregnancy Outcome (Statistics) Unit 
Epidemiology Branch 
SA Health, Government of South Australia 
Citi Centre Building 
11 Hindmarsh Square  
Adelaide 5000 South Australia

Postal Address 
Pregnancy Outcome (Statistics) Unit 
SA Health, Government of South Australia  
PO Box 6 Rundle Mall 
Adelaide  5000 South Australia 
Telephone: (08) 8226 6382 
Fax: (08) 8226 6291 
Web: www.sahealth.sa.gov.au/pregnancyoutcomes  
E-mail: Pregnancy.Stats@health.sa.gov.au

Public-I2-A1

  Department for Health and Ageing, Government of South Australia.  
All rights reserved.  FIS: 15116.1   ISSN: 0819-3835  ISBN: 978-1-74243-807-8  Printed November 2015.

www.ausgoal.gov.au/creative-commons



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